Healthcare Provider Details

I. General information

NPI: 1679779938
Provider Name (Legal Business Name): KELLY J HUGHES MS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 MAIN ST
FREMONT NH
03044-3434
US

IV. Provider business mailing address

15 ARBOR ST #2
EXETER NH
03833-2634
US

V. Phone/Fax

Practice location:
  • Phone: 603-895-3126
  • Fax:
Mailing address:
  • Phone: 617-460-6326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0683
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: