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General NPI Number Information
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NPI Number | 1174809933
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Entity Type | Individual
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Provider Name | ALISHA N KELLY MS, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 10/25/2011
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Last Update Date | 10/25/2011
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Provider Practice Location Address
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Address Line | 1220 E 8TH ST
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City | GALENA
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State | KS
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Zip | 66739-1865
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Country | US
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Telephone | 620-783-1383
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Fax |
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Provider Business Mailing Address
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Address Line | 727 CHERRY ST
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City | NEOSHO
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State | MO
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Zip | 64850-2406
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Country | US
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Telephone | 417-592-2028
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Fax |
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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 | 3291
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License Number State | KS
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