Provider Demographics
NPI:1942598586
Name:WOOD, KELLY LEIGH
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LEIGH
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 TATTERSALL DR
Mailing Address - Street 2:
Mailing Address - City:WEST DEPTFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08051-1734
Mailing Address - Country:US
Mailing Address - Phone:856-904-9433
Mailing Address - Fax:
Practice Address - Street 1:3809 BAYSHORE RD
Practice Address - Street 2:
Practice Address - City:NORTH CAPE MAY
Practice Address - State:NJ
Practice Address - Zip Code:08204-3259
Practice Address - Country:US
Practice Address - Phone:609-898-0677
Practice Address - Fax:609-898-1186
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTL-1978235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist