Healthcare Provider Details

I. General information

NPI: 1750292165
Provider Name (Legal Business Name): KELLY JEAN RAGAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 PONTIAC ST
OXFORD MI
48371-4847
US

IV. Provider business mailing address

109 PONTIAC ST
OXFORD MI
48371-4847
US

V. Phone/Fax

Practice location:
  • Phone: 248-969-5075
  • Fax: 248-969-5085
Mailing address:
  • Phone: 248-969-5075
  • Fax: 248-969-5085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101003129
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: