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NPI Code Detail

MEDICARE: KELLY ANN DECAIRE M.A CCC-SLP

MEDICARE: KELLY ANN DECAIRE M.A 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
1235Z00000XSpeech-Language Pathologist5992MA

Other Identifiers

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

General Provider Information

NPI Number : 1255801171
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY ANN DECAIRE M.A CCC-SLP
Provider Business Mailing Address
First Line : 2701 CHESTNUT STATION CT
Second Line :
City : LOUISVILLE
State : KY
Zip : 40299-6395
Country : US
Telephone Number : 800-335-1060
Fax Number :
Provider Business Practice Location Address
First Line : 85 BEAUMONT DR
Second Line :
City : NORTHBRIDGE
State : MA
Zip : 01534-1093
Country : US
Telephone Number : 508-321-7975
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2018
Last Update Date : 12/04/2018

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