Provider Demographics
NPI:1023154028
Name:DANIEL, KELLY LEE (CCC-A)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LEE
Last Name:DANIEL
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 THREE SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-7552
Mailing Address - Country:US
Mailing Address - Phone:270-746-7816
Mailing Address - Fax:270-746-7877
Practice Address - Street 1:495 THREE SPRINGS RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-7552
Practice Address - Country:US
Practice Address - Phone:270-746-7816
Practice Address - Fax:270-746-7877
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0185231H00000X
KY0883237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist