Healthcare Provider Details

I. General information

NPI: 1649760778
Provider Name (Legal Business Name): KATHLEEN ANNE KELLY AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26900 CEDAR RD
BEACHWOOD OH
44122-1191
US

IV. Provider business mailing address

19754 NOB HL
STRONGSVILLE OH
44136-7200
US

V. Phone/Fax

Practice location:
  • Phone: 216-839-3000
  • Fax:
Mailing address:
  • Phone: 440-503-5519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberA02137
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: