Provider Demographics
NPI:1780379537
Name:KELLEY, JENNIFER (MS CCC/SLP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WINTERBERRY DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-8821
Mailing Address - Country:US
Mailing Address - Phone:940-634-1872
Mailing Address - Fax:
Practice Address - Street 1:2449 STATE ROUTE 118 STE 2
Practice Address - Street 2:
Practice Address - City:HUNLOCK CREEK
Practice Address - State:PA
Practice Address - Zip Code:18621-5022
Practice Address - Country:US
Practice Address - Phone:570-690-4908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist