Provider Demographics
NPI:1457597619
Name:KELLY, JESSICA (AUD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 WAYNE AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3578
Mailing Address - Country:US
Mailing Address - Phone:724-349-5440
Mailing Address - Fax:724-349-7445
Practice Address - Street 1:1265 WAYNE AVE
Practice Address - Street 2:STE 100
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3578
Practice Address - Country:US
Practice Address - Phone:724-349-5440
Practice Address - Fax:724-349-7445
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006101237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter