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General NPI Number Information
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NPI Number | 1164308987
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Entity Type | Individual
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Provider Name | KELLY LYNN DEJONG MA,CF-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/15/2025
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 1306 HIGHWAY 57 STE B
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City | PARKERSBURG
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State | IA
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Zip | 50665-1075
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Country | US
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Telephone | 319-346-9783
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Fax | 319-346-9785
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Provider Business Mailing Address
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Address Line | 1306 HIGHWAY 57 STE B
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City | PARKERSBURG
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State | IA
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Zip | 50665-1075
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Country | US
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Telephone | 319-346-9783
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Fax | 319-346-9785
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 129834
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License Number State | IA
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