Provider Demographics
NPI:1952708174
Name:METCALF-LATTIME, KELLY KRISTINE
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:KRISTINE
Last Name:METCALF-LATTIME
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:KRISTINE
Other - Last Name:METCALF-LATTIME
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:3471 WHITBURN CIR
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44286-9050
Mailing Address - Country:US
Mailing Address - Phone:330-931-1441
Mailing Address - Fax:
Practice Address - Street 1:1020 HARTFORD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44301
Practice Address - Country:US
Practice Address - Phone:330-761-7934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4362235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist