Provider Demographics
NPI:1891027744
Name:SALMON, KELLY MUIR
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:MUIR
Last Name:SALMON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:ANNE
Other - Last Name:MUIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:136 ST. MATTHEWS AVE
Mailing Address - Street 2:#300
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207
Mailing Address - Country:US
Mailing Address - Phone:502-897-1700
Mailing Address - Fax:
Practice Address - Street 1:22950 NORTHLINE RD.
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-6912
Practice Address - Country:US
Practice Address - Phone:734-287-1230
Practice Address - Fax:734-287-8332
Is Sole Proprietor?:No
Enumeration Date:2010-02-03
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL009765235Z00000X
MI7101002672235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist