Provider Demographics
NPI:1831411941
Name:KELLY, ERIN CHRISTINE (MS,CCC-SLP/L)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:CHRISTINE
Last Name:KELLY
Suffix:
Gender:F
Credentials:MS,CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 S COTTAGE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-5278
Mailing Address - Country:US
Mailing Address - Phone:309-826-1253
Mailing Address - Fax:
Practice Address - Street 1:722 STONEBRIDGE CENTER RD
Practice Address - Street 2:
Practice Address - City:RANTOUL
Practice Address - State:IL
Practice Address - Zip Code:61866
Practice Address - Country:US
Practice Address - Phone:309-826-1253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146009634235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist