MEDICARE: MS. SHANA L 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	LL00003194	WA

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
2	204367673	OTHER	WA	TAX ID
3	1508829052	OTHER	WA	CHILDREN'S COMMUNICATION CORNER NPI
4	6704KE	OTHER	WA	REGENCE

General Provider Information

NPI Number	:	1235277997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHANA L KELLY M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	4115 UNIVERSITY WAY NE
Second Line	:	STE 202
City	:	SEATTLE
State	:	WA
Zip	:	98105-6257
Country	:	US
Telephone Number	:	206-299-1780
Fax Number	:	206-524-9836

Provider Business Practice Location Address
First Line	:	4115 UNIVERSITY WAY NE
Second Line	:	STE 202
City	:	SEATTLE
State	:	WA
Zip	:	98105-6257
Country	:	US
Telephone Number	:	206-299-1780
Fax Number	:	206-524-9836

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	10/28/2014

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Directions to “ MS. SHANA L KELLY M.S., CCC-SLP” Practice Location

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