Provider Demographics
NPI:1922264043
Name:EWING, KELLY M (AUD)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:EWING
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EAST PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-2212
Mailing Address - Country:US
Mailing Address - Phone:650-617-2270
Mailing Address - Fax:650-617-2266
Practice Address - Street 1:1900 UNIVERSITY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:EAST PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-2212
Practice Address - Country:US
Practice Address - Phone:650-617-2270
Practice Address - Fax:650-617-2266
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2295231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAU2295OtherAUDOLOGIST LICS.