Healthcare Provider Details

I. General information

NPI: 1730009895
Provider Name (Legal Business Name): COURTNEY L KELLY M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. HEATHER COURTNEY KELLY

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 ABBY LN
ASHEBORO NC
27205-2300
US

IV. Provider business mailing address

225 ABBY LN
ASHEBORO NC
27205-2300
US

V. Phone/Fax

Practice location:
  • Phone: 336-736-0623
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5485
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: