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NPI Code Detail

MEDICARE: KELLY NOELLE SOUTHERLAND M.S., CCC-SLP

MEDICARE: KELLY NOELLE SOUTHERLAND M.S., 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
1235Z00000XSpeech-Language PathologistSP15202CA

General Provider Information

NPI Number : 1356787907
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY NOELLE SOUTHERLAND M.S., CCC-SLP
Provider Business Mailing Address
First Line : 53 VALLEY ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94110-4921
Country : US
Telephone Number : 415-378-6069
Fax Number : 415-695-1463
Provider Business Practice Location Address
First Line : 3401 MISSION ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94110-5419
Country : US
Telephone Number : 415-378-6069
Fax Number : 415-695-1463
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2013
Last Update Date : 05/21/2013

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Directions to “ KELLY NOELLE SOUTHERLAND M.S., CCC-SLP” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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