Provider Demographics
NPI:1134427180
Name:KELLS, LYNN DORIS (CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:DORIS
Last Name:KELLS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 FREMONT RD
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-2696
Mailing Address - Country:US
Mailing Address - Phone:315-434-3050
Mailing Address - Fax:
Practice Address - Street 1:407 FREMONT RD
Practice Address - Street 2:
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-2696
Practice Address - Country:US
Practice Address - Phone:315-434-3050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004194-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist