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General NPI Number Information
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NPI Number | 1306701719
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Entity Type | Individual
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Provider Name | MAUREEN E KELLY
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Gender | Female
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Dates
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Enumeration Date | 12/17/2025
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 1341 HAMBURG TPKE
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City | WAYNE
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State | NJ
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Zip | 07470-4060
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Country | US
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Telephone | 973-464-2197
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Fax |
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Provider Business Mailing Address
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Address Line | 35 GLENDALE DR
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City | HILLSDALE
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State | NJ
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Zip | 07642-2747
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Country | US
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Telephone |
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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 | 41YS00874000
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License Number State | NJ
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