Provider Demographics
NPI:1063716314
Name:KELLY, MARCEL BONDI (MS CCC-LSLP)
Entity type:Individual
Prefix:MRS
First Name:MARCEL
Middle Name:BONDI
Last Name:KELLY
Suffix:
Gender:F
Credentials:MS CCC-LSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 MEDITERRANEAN DR
Mailing Address - Street 2:
Mailing Address - City:ALLEGANY
Mailing Address - State:NY
Mailing Address - Zip Code:14706-9503
Mailing Address - Country:US
Mailing Address - Phone:716-373-1308
Mailing Address - Fax:
Practice Address - Street 1:4041 MEDITERRANEAN DR
Practice Address - Street 2:
Practice Address - City:ALLEGANY
Practice Address - State:NY
Practice Address - Zip Code:14706-9503
Practice Address - Country:US
Practice Address - Phone:716-373-1308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005698-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005698-1OtherSPEECH LANGUAGE PATHOLOGIST LICENSE NUMBER