Provider Demographics
NPI:1124329313
Name:KELLY, KAREN J (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:J
Last Name:KELLY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:J
Other - Last Name:KELLY-K'MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:2300 TRUXTUN AVE
Mailing Address - Street 2:STE. 100
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3542
Mailing Address - Country:US
Mailing Address - Phone:661-323-4591
Mailing Address - Fax:661-323-8603
Practice Address - Street 1:2300 TRUXTUN AVE
Practice Address - Street 2:STE. 100
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3542
Practice Address - Country:US
Practice Address - Phone:661-323-4591
Practice Address - Fax:661-323-8603
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12598235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist