Provider Demographics
NPI:1649513557
Name:KELLEY, CORRINA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:CORRINA
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 MILL RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03848-3433
Mailing Address - Country:US
Mailing Address - Phone:617-447-6560
Mailing Address - Fax:
Practice Address - Street 1:54 MILL RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NH
Practice Address - Zip Code:03848-3433
Practice Address - Country:US
Practice Address - Phone:617-447-6560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1242235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist