Provider Demographics
NPI:1124831557
Name:RONCO, KELLLY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KELLLY
Middle Name:
Last Name:RONCO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 LONG LN STE 2
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1734
Mailing Address - Country:US
Mailing Address - Phone:207-460-0209
Mailing Address - Fax:
Practice Address - Street 1:5 LONG LN STE 2
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1734
Practice Address - Country:US
Practice Address - Phone:207-460-0209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP2999235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist