Provider Demographics
NPI:1154747434
Name:COULOMBE, KELLENE MCCALL (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KELLENE
Middle Name:MCCALL
Last Name:COULOMBE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 INDEPENDENCE DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-6874
Mailing Address - Country:US
Mailing Address - Phone:856-469-7187
Mailing Address - Fax:
Practice Address - Street 1:102 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-6874
Practice Address - Country:US
Practice Address - Phone:856-469-7187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-11
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00729200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist