Provider Demographics
NPI:1669140844
Name:KELLY, VANESSA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:KELLY TORRES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:2818 RIDGE BERRY RD
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-6593
Mailing Address - Country:US
Mailing Address - Phone:787-206-1353
Mailing Address - Fax:
Practice Address - Street 1:2951 BLANCO VISTA BLVD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-5234
Practice Address - Country:US
Practice Address - Phone:512-268-8506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111950235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist