Healthcare Provider Details

I. General information

NPI: 1093630311
Provider Name (Legal Business Name): SKYLAR JO KELLY M.S. CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 S 2ND ST
NORFOLK NE
68701-6323
US

IV. Provider business mailing address

512 W PHILLIP AVE
NORFOLK NE
68701-5208
US

V. Phone/Fax

Practice location:
  • Phone: 402-644-2557
  • Fax:
Mailing address:
  • Phone: 402-644-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1154
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: