Provider Demographics
NPI:1073362745
Name:MCCARTHY, KELLEY SHARKEY (MS,L-SLP,CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:SHARKEY
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:MS,L-SLP,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:DONALDSONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70346-2754
Mailing Address - Country:US
Mailing Address - Phone:225-391-7000
Mailing Address - Fax:
Practice Address - Street 1:1100 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:DONALDSONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70346-2754
Practice Address - Country:US
Practice Address - Phone:225-391-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4296235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist