Provider Demographics
NPI:1134797483
Name:KELLY, PLESHETTE JOHNSON (MA)
Entity type:Individual
Prefix:
First Name:PLESHETTE
Middle Name:JOHNSON
Last Name:KELLY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:PLESHETTE
Other - Middle Name:SHONTEE
Other - Last Name:JOHNSON-KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED
Mailing Address - Street 1:128 STONEY POINT LN
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:SC
Mailing Address - Zip Code:29036-8841
Mailing Address - Country:US
Mailing Address - Phone:520-576-6795
Mailing Address - Fax:
Practice Address - Street 1:128 STONEY POINT LN
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:SC
Practice Address - Zip Code:29036-8841
Practice Address - Country:US
Practice Address - Phone:520-576-6795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-14
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSLP.7629235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist