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General NPI Number Information
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NPI Number | 1245983196
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Entity Type | Individual
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Provider Name | CAITLIN KELLEY CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 02/01/2022
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Last Update Date | 01/11/2023
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Provider Practice Location Address
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Address Line | 4251 SARON DR
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City | LEXINGTON
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State | KY
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Zip | 40515-7005
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Country | US
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Telephone | 606-574-0375
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Fax |
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Provider Business Mailing Address
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Address Line | 3659 IRON LACE DR
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City | LEXINGTON
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State | KY
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Zip | 40509-2342
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Country | US
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Telephone | 606-584-0375
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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 | 264339
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License Number State | KY
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