Provider Demographics
NPI:1336369107
Name:FABBRI, KELLY J (SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:J
Last Name:FABBRI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5203 BRISCOE RD
Mailing Address - Street 2:
Mailing Address - City:PARKERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26105-8124
Mailing Address - Country:US
Mailing Address - Phone:304-428-5544
Mailing Address - Fax:
Practice Address - Street 1:5203 BRISCOE RD
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26105-8124
Practice Address - Country:US
Practice Address - Phone:304-428-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0747235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist