Provider Demographics
NPI:1801272778
Name:GORMAN, KELLY (MS CCC SLP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:GORMAN
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 1:1885 CHERRYVILLE RD
Mailing Address - Street 2:C/O AAC SPECIALISTS, LLC
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80121-1504
Mailing Address - Country:US
Mailing Address - Phone:303-204-5188
Mailing Address - Fax:303-761-9491
Practice Address - Street 1:1885 CHERRYVILLE RD
Practice Address - Street 2:C/O AAC SPECIALISTS, LLC
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80121-1504
Practice Address - Country:US
Practice Address - Phone:303-204-5188
Practice Address - Fax:303-761-9491
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO14066997(ASHA)235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist