Healthcare Provider Details

I. General information

NPI: 1821243908
Provider Name (Legal Business Name): KELLY M HUGGINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 SOUTHWOODS DR
MONTICELLO NY
12701-7231
US

IV. Provider business mailing address

335 FORT VAN TYLE RD
PORT JERVIS NY
12771-3641
US

V. Phone/Fax

Practice location:
  • Phone: 845-794-6037
  • Fax:
Mailing address:
  • Phone: 845-355-3747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number012084
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: