Provider Demographics
NPI:1811229800
Name:MOULDEN, KELLIN (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KELLIN
Middle Name:
Last Name:MOULDEN
Suffix:
Gender:
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:KELLIN
Other - Middle Name:
Other - Last Name:MCKINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:5007 7TH PL NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-4019
Mailing Address - Country:US
Mailing Address - Phone:336-416-3424
Mailing Address - Fax:
Practice Address - Street 1:2100 MASSACHUSETTS AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2807
Practice Address - Country:US
Practice Address - Phone:855-428-8246
Practice Address - Fax:855-428-8246
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4608235Z00000X
DCSLP200001712235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCSLP200001712OtherSLP LICENSE