MEDICARE: MISS KELLY ELIZABETH NEW M.A. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP11644	OH

General Provider Information

NPI Number	:	1215334750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KELLY ELIZABETH NEW M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	70 NORTH BROADWAY
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44308-3458
Country	:	US
Telephone Number	:	330-761-1661
Fax Number	:

Provider Business Practice Location Address
First Line	:	985 GORGE BLVD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44310-2407
Country	:	US
Telephone Number	:	330-761-2665
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2014
Last Update Date	:	11/20/2017

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Directions to “ MISS KELLY ELIZABETH NEW M.A. CCC-SLP” Practice Location

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