Provider Demographics
NPI:1962629741
Name:KELLEY, KIMBERLY ANNE (AUD, CCC-A)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANNE
Last Name:KELLEY
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2365 ELKRIDGE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48356
Mailing Address - Country:US
Mailing Address - Phone:248-889-0628
Mailing Address - Fax:
Practice Address - Street 1:9640 COMMERCE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:COMMERCE TWP
Practice Address - State:MI
Practice Address - Zip Code:48382-4111
Practice Address - Country:US
Practice Address - Phone:248-360-8825
Practice Address - Fax:248-360-8897
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000165237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter