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NPI Code Detail

MEDICARE: CHARLEEN A KELLY MA, CCCSLP, PHD

MEDICARE: CHARLEEN A KELLY MA, CCCSLP, PHD
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 PathologistLL00002598WA

General Provider Information

NPI Number : 1699940130
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLEEN A KELLY MA, CCCSLP, PHD
Provider Business Mailing Address
First Line : 402 91ST AVE NE
Second Line :
City : LAKE STEVENS
State : WA
Zip : 98258-2530
Country : US
Telephone Number : 425-334-4071
Fax Number :
Provider Business Practice Location Address
First Line : 402 91ST AVE NE
Second Line :
City : LAKE STEVENS
State : WA
Zip : 98258-2530
Country : US
Telephone Number : 425-334-4071
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2008
Last Update Date : 04/25/2008

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Directions to “ CHARLEEN A KELLY MA, CCCSLP, PHD” Practice Location

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