Provider Demographics
NPI:1215334750
Name:NEW, KELLY ELIZABETH (MA CCC-SLP)
Entity type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:ELIZABETH
Last Name:NEW
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 NORTH BROADWAY
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44308-3458
Mailing Address - Country:US
Mailing Address - Phone:330-761-1661
Mailing Address - Fax:
Practice Address - Street 1:985 GORGE BLVD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-2407
Practice Address - Country:US
Practice Address - Phone:330-761-2665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-27
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP11644235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist