Basic Information
| Provider Information | |||||||||
| NPI: | 1346915816 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KELLY | ||||||||
| FirstName: | MEGAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | CF-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20953 ANN AVE | ||||||||
| Address2: | |||||||||
| City: | REHOBOTH BEACH | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199711963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3023881930 | ||||||||
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| Practice Location | |||||||||
| Address1: | 61 CORPORATE CIRCLE | ||||||||
| Address2: | |||||||||
| City: | NEW CASTLE | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197202405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3023244444 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2021 | ||||||||
| LastUpdateDate: | 08/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | O4-0010752 | DE | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.