Provider Demographics
NPI:1912292723
Name:GAGNON, KELLY REED (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:REED
Last Name:GAGNON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:LYNN
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25391 BROOKVIEW ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-1324
Mailing Address - Country:US
Mailing Address - Phone:248-579-3330
Mailing Address - Fax:
Practice Address - Street 1:25391 BROOKVIEW ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-1324
Practice Address - Country:US
Practice Address - Phone:248-579-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI71010000745235Z00000X
12134217235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist