MEDICARE: KELLY R MARCONYAK SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1073658506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY R MARCONYAK SLP

Provider Business Mailing Address
First Line	:	159 PICKETT MILL BLVD
Second Line	:
City	:	BLUFFTON
State	:	SC
Zip	:	29909-7831
Country	:	US
Telephone Number	:	808-281-4067
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 MARSHELLEN DR
Second Line	:
City	:	BEAUFORT
State	:	SC
Zip	:	29902-6900
Country	:	US
Telephone Number	:	843-579-8333
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	05/07/2024

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Directions to “ KELLY R MARCONYAK SLP” Practice Location

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