Provider Demographics
NPI:1134366313
Name:SCHIRMER, KELLY J (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:J
Last Name:SCHIRMER
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 1:5648 SUTTON RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:NY
Mailing Address - Zip Code:14414-9719
Mailing Address - Country:US
Mailing Address - Phone:585-226-2979
Mailing Address - Fax:
Practice Address - Street 1:5648 SUTTON RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:NY
Practice Address - Zip Code:14414-9719
Practice Address - Country:US
Practice Address - Phone:585-226-2979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009255-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist