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General NPI Number Information
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NPI Number | 1205132495
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Entity Type | Individual
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Provider Name | KELLY LYN GRANT M.S.ED, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 02/04/2011
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 1353 STATE ROUTE 7
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City | RICHMONDVILLE
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State | NY
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Zip | 12149-2303
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Country | US
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Telephone | 518-234-3565
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Fax |
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Provider Business Mailing Address
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Address Line | 118 WHISPERING PINES DR
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City | GILBOA
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State | NY
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Zip | 12076-2308
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Country | US
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Telephone | 607-434-4362
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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 | 010332-1
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License Number State | NY
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