MEDICARE: KELLOGG SPEECH LANGUAGE LEARNING SERVICES

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	:	1780216580
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KELLOGG SPEECH LANGUAGE LEARNING SERVICES

Provider Business Mailing Address
First Line	:	2302 CRANES CV
Second Line	:
City	:	BURTON
State	:	MI
Zip	:	48519-1368
Country	:	US
Telephone Number	:	810-730-4110
Fax Number	:

Provider Business Practice Location Address
First Line	:	8323 OFFICE PARK DR STE C4
Second Line	:
City	:	GRAND BLANC
State	:	MI
Zip	:	48439-2068
Country	:	US
Telephone Number	:	810-730-4110
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KATHRYN KELLOGG
Credential	:
Telephone Number	:	810-730-4110

Provider Enumeration Date	:	02/10/2020
Last Update Date	:	10/13/2020

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Directions to “KELLOGG SPEECH LANGUAGE LEARNING SERVICES ” Practice Location

Language	Start Address	Practice Location

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