MEDICARE: MISS LESLIE ANN KELLY M.S., CCC-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	SA880	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225434814
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LESLIE ANN KELLY M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	2104 VISION DRIVE
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418
Country	:	US
Telephone Number	:	561-312-1198
Fax Number	:

Provider Business Practice Location Address
First Line	:	11911 US HIGHWAY 1 STE 102
Second Line	:
City	:	NORTH PALM BEACH
State	:	FL
Zip	:	33408-2872
Country	:	US
Telephone Number	:	561-694-7661
Fax Number	:

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

Provider Enumeration Date	:	11/10/2014
Last Update Date	:	11/10/2014

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Directions to “ MISS LESLIE ANN KELLY M.S., CCC-SLP” Practice Location

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