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NPI Code Detail

MEDICARE: KELLY DOUGHERTY M.S., CCC-SLP

MEDICARE: KELLY DOUGHERTY 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 Pathologist146005478IL

General Provider Information

NPI Number : 1366504821
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY DOUGHERTY M.S., CCC-SLP
Provider Business Mailing Address
First Line : 7639 LARAMIE AVE
Second Line :
City : SKOKIE
State : IL
Zip : 60077-2836
Country : US
Telephone Number : 847-410-7004
Fax Number :
Provider Business Practice Location Address
First Line : 1936 GREEN BAY RD
Second Line :
City : HIGHLAND PARK
State : IL
Zip : 60035-3112
Country : US
Telephone Number : 224-765-3000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2006
Last Update Date : 01/25/2018

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

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