Provider Demographics
NPI:1811466154
Name:MARKOWITZ, KELLY ANN (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:MARKOWITZ
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 1:8583 PATHFINDER RD
Mailing Address - Street 2:
Mailing Address - City:BREINIGSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18031-1470
Mailing Address - Country:US
Mailing Address - Phone:484-221-8029
Mailing Address - Fax:
Practice Address - Street 1:8583 PATHFINDER RD
Practice Address - Street 2:
Practice Address - City:BREINIGSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18031-1470
Practice Address - Country:US
Practice Address - Phone:484-221-8029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL014306235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist