Provider Demographics
NPI:1801079918
Name:ZODY, KELLY ANNE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:ZODY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANNE
Other - Last Name:HINDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2306 TRIGGERFISH COURT
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-9826
Mailing Address - Country:US
Mailing Address - Phone:727-641-2341
Mailing Address - Fax:
Practice Address - Street 1:2306 TRIGGERFISH COURT
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-9826
Practice Address - Country:US
Practice Address - Phone:727-641-2341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9093235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL892617400Medicaid