Provider Demographics
NPI:1134372220
Name:KOLMETZ, KELLY JEAN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:JEAN
Last Name:KOLMETZ
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 PINNACLE ROAD
Mailing Address - Street 2:
Mailing Address - City:RUSH
Mailing Address - State:NY
Mailing Address - Zip Code:14543
Mailing Address - Country:US
Mailing Address - Phone:585-271-0761
Mailing Address - Fax:
Practice Address - Street 1:2817 PINNACLE RD
Practice Address - Street 2:
Practice Address - City:RUSH
Practice Address - State:NY
Practice Address - Zip Code:14543-9707
Practice Address - Country:US
Practice Address - Phone:585-271-0761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013472-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist