Provider Demographics
NPI:1154515112
Name:ZILLI, KELLY ANN (AUD DOCTOR OF AUDIOL)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:ZILLI
Suffix:
Gender:F
Credentials:AUD DOCTOR OF AUDIOL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:2421 MONROE ST
Mailing Address - Street 2:STE 202
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124
Mailing Address - Country:US
Mailing Address - Phone:313-562-4485
Mailing Address - Fax:313-562-0447
Practice Address - Street 1:2421 MONROE ST
Practice Address - Street 2:STE 202
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124
Practice Address - Country:US
Practice Address - Phone:313-562-4485
Practice Address - Fax:313-562-0447
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501002597231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4687710Medicaid
MI0P04230Medicare PIN