Provider Demographics
NPI:1295518744
Name:KELLEY, QUINN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:QUINN
Middle Name:
Last Name:KELLEY
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 1:409 LACKAWANNA AVE APT 302
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-2086
Mailing Address - Country:US
Mailing Address - Phone:570-780-5995
Mailing Address - Fax:
Practice Address - Street 1:187 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:HAWLEY
Practice Address - State:PA
Practice Address - Zip Code:18428-7003
Practice Address - Country:US
Practice Address - Phone:570-780-5995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist