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General NPI Number Information
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NPI Number | 1578696399
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Entity Type | Individual
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Provider Name | KELLY LEE COLCLASURE MS CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 3380 E MAIN ST
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City | DANVILLE
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State | IN
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Zip | 46122-9089
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Country | US
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Telephone | 317-178-0089
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Fax | 317-718-0097
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Provider Business Mailing Address
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Address Line | 5814 EAST COUNTY ROAD 100 NORTH
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City | AVON
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State | IN
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Zip | 46123
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Country | US
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Telephone | 317-745-4739
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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 | 22004397A
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License Number State | IN
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