Healthcare Provider Details

I. General information

NPI: 1306701719
Provider Name (Legal Business Name): MAUREEN E KELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 HAMBURG TPKE
WAYNE NJ
07470-4060
US

IV. Provider business mailing address

35 GLENDALE DR
HILLSDALE NJ
07642-2747
US

V. Phone/Fax

Practice location:
  • Phone: 973-464-2197
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41YS00874000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: