Healthcare Provider Details

I. General information

NPI: 1548543663
Provider Name (Legal Business Name): KELLY S GRIFFIN MA. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2011
Last Update Date: 04/22/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 RIVERMONT AVE
LYNCHBURG VA
24503-2030
US

IV. Provider business mailing address

3816 COTTONTOWN RD
FOREST VA
24551-4928
US

V. Phone/Fax

Practice location:
  • Phone: 434-200-5032
  • Fax:
Mailing address:
  • Phone: 704-650-7457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9477
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202011219
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: