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NPI Code Detail

MEDICARE: LEEANN KELLEY MS, CCC-SLP

MEDICARE: LEEANN KELLEY 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
1235Z00000XSpeech-Language Pathologist1642NH

General Provider Information

NPI Number : 1811351547
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEEANN KELLEY MS, CCC-SLP
Provider Business Mailing Address
First Line : 29 PROVIDENCE AVE
Second Line :
City : BERLIN
State : NH
Zip : 03570-3130
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 29 PROVIDENCE AVE
Second Line :
City : BERLIN
State : NH
Zip : 03570-3130
Country : US
Telephone Number : 603-752-1420
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2016
Last Update Date : 04/08/2016

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Directions to “ LEEANN KELLEY MS, CCC-SLP” Practice Location

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