Provider Demographics
NPI:1215149653
Name:KELLEY, DARCY B (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:DARCY
Middle Name:B
Last Name:KELLEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17924 140TH AVE NE
Mailing Address - Street 2:SUITE #200
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-4315
Mailing Address - Country:US
Mailing Address - Phone:425-424-8755
Mailing Address - Fax:425-424-9201
Practice Address - Street 1:17924 140TH AVE NE
Practice Address - Street 2:SUITE #200
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-4315
Practice Address - Country:US
Practice Address - Phone:425-424-8755
Practice Address - Fax:425-424-9201
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00001624235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist