Provider Demographics
NPI:1891214474
Name:KELLEY, KATIE ANN (AUD)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:ANN
Last Name:KELLEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:ANN
Other - Last Name:RUGGIERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:702 MASON RD
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2318
Mailing Address - Country:US
Mailing Address - Phone:443-496-2450
Mailing Address - Fax:
Practice Address - Street 1:6355 WALKER LN STE 411
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3250
Practice Address - Country:US
Practice Address - Phone:703-922-4262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001641231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist