MEDICARE: MISS KELLY L. WALISZEK MS, 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	1117	NH
2	235Z00000X	Speech-Language Pathologist	SP2634	ME

General Provider Information

NPI Number	:	1376668517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KELLY L. WALISZEK MS, CCC-SLP

Provider Business Mailing Address
First Line	:	10 OLD QUARRY RD
Second Line	:
City	:	CAPE NEDDICK
State	:	ME
Zip	:	03902-7505
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10 OLD QUARRY RD
Second Line	:
City	:	CAPE NEDDICK
State	:	ME
Zip	:	03902-7505
Country	:	US
Telephone Number	:	603-343-8965
Fax Number	:

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	05/29/2024

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Directions to “ MISS KELLY L. WALISZEK MS, CCC-SLP” Practice Location

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