Provider Demographics
NPI:1841313939
Name:CALLAHAN, KELLYANN B (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:KELLYANN
Middle Name:B
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 AVONDALE DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-7749
Mailing Address - Country:US
Mailing Address - Phone:330-835-1728
Mailing Address - Fax:330-835-1728
Practice Address - Street 1:155 HERITAGE WOODS DR
Practice Address - Street 2:
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-1398
Practice Address - Country:US
Practice Address - Phone:330-666-0980
Practice Address - Fax:330-666-5585
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP5391235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist