Provider Demographics
NPI:1720697550
Name:SPEECH BY KELLY
Entity Type:Organization
Organization Name:SPEECH BY KELLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-524-2058
Mailing Address - Street 1:1215 CORPORATE CIR SW STE 201
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-1400
Mailing Address - Country:US
Mailing Address - Phone:540-312-7066
Mailing Address - Fax:
Practice Address - Street 1:4903 STARKEY RD STE 200D
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-8525
Practice Address - Country:US
Practice Address - Phone:540-524-2058
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty