Healthcare Provider Details

I. General information

NPI: 1457558264
Provider Name (Legal Business Name): LINDA A. KELLEY MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINDA ALISE KELLEY MA, CCC-SLP

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E BELTLINE AVE NE STE 220
GRAND RAPIDS MI
49506-1267
US

IV. Provider business mailing address

330 E BELTLINE AVE NE STE 220
GRAND RAPIDS MI
49506-1267
US

V. Phone/Fax

Practice location:
  • Phone: 616-260-3013
  • Fax: 616-935-0748
Mailing address:
  • Phone: 616-260-3013
  • Fax: 616-935-0748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101000074
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: