Healthcare Provider Details

I. General information

NPI: 1194854166
Provider Name (Legal Business Name): MRS. KELLY ANNE HART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 SPUR CIR
SCOTTSDALE AZ
85251-5461
US

IV. Provider business mailing address

32 SPUR CIR
SCOTTSDALE AZ
85251-5461
US

V. Phone/Fax

Practice location:
  • Phone: 480-945-0185
  • Fax: 480-656-3948
Mailing address:
  • Phone: 480-945-0185
  • Fax: 480-656-3948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSLPA6306
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP5101
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: