Provider Demographics
NPI:1003103375
Name:MCGUIRE, KELLY M (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:M
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3077 SIGNATURE BLVD
Mailing Address - Street 2:APT. B
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6927
Mailing Address - Country:US
Mailing Address - Phone:949-233-1982
Mailing Address - Fax:
Practice Address - Street 1:11930 WHITMORE LAKE RD
Practice Address - Street 2:SUITE L-M
Practice Address - City:WHITMORE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48189-9153
Practice Address - Country:US
Practice Address - Phone:734-449-4649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12145015235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist