Provider Demographics
NPI:1821100470
Name:KELLEY, KAIRN STETLER (PHD, MS/CCC-A)
Entity type:Individual
Prefix:DR
First Name:KAIRN
Middle Name:STETLER
Last Name:KELLEY
Suffix:
Gender:F
Credentials:PHD, MS/CCC-A
Other - Prefix:DR
Other - First Name:ROCKY
Other - Middle Name:KAIRN
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, MS/CCC-A
Mailing Address - Street 1:1 ALLEN ROW
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:VT
Mailing Address - Zip Code:05602-3753
Mailing Address - Country:US
Mailing Address - Phone:802-223-8150
Mailing Address - Fax:802-225-7104
Practice Address - Street 1:1 ALLEN ROW
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-3753
Practice Address - Country:US
Practice Address - Phone:802-338-5912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010446Medicaid
KE040264Medicare ID - Type Unspecified
VT1010446Medicaid