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NPI Code Detail

MEDICARE: MRS. KELLY J PERRY CCC-SLP

MEDICARE: MRS. KELLY J PERRY 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 Pathologist15258CA

General Provider Information

NPI Number : 1720385040
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLY J PERRY CCC-SLP
Provider Business Mailing Address
First Line : 4203 E OVERLOOK DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92115-6110
Country : US
Telephone Number : 805-216-4822
Fax Number :
Provider Business Practice Location Address
First Line : 7840 MISSION CENTER CT STE 200
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-1320
Country : US
Telephone Number : 619-299-1411
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2011
Last Update Date : 02/23/2011

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Directions to “ MRS. KELLY J PERRY CCC-SLP” Practice Location

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