Provider Demographics
NPI:1649642455
Name:GALLAGHER, KELLYE LYNNE (CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:KELLYE
Middle Name:LYNNE
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 PEARL AVE
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:PA
Mailing Address - Zip Code:19070-1243
Mailing Address - Country:US
Mailing Address - Phone:484-557-5615
Mailing Address - Fax:
Practice Address - Street 1:820 PEARL AVE
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:PA
Practice Address - Zip Code:19070-1243
Practice Address - Country:US
Practice Address - Phone:484-557-5615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL012691235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist