MEDICARE: MRS. MELANIE ANN KELLY MCD, 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	2168	AL

General Provider Information

NPI Number	:	1619183480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELANIE ANN KELLY MCD, CCC-SLP

Provider Business Mailing Address
First Line	:	2326 DAWSON CIR
Second Line	:
City	:	ALEXANDER CITY
State	:	AL
Zip	:	35010-7158
Country	:	US
Telephone Number	:	256-234-4616
Fax Number	:

Provider Business Practice Location Address
First Line	:	2326 DAWSON CIR
Second Line	:
City	:	ALEXANDER CITY
State	:	AL
Zip	:	35010-7158
Country	:	US
Telephone Number	:	256-234-4616
Fax Number	:

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

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/08/2007

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