Provider Demographics
NPI:1215353412
Name:CANIGLIA, KELLEY
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:CANIGLIA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KELLEY
Other - Middle Name:JO
Other - Last Name:CANIGLIA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA CCC-SLP
Mailing Address - Street 1:9999 INDEPENDENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-4644
Mailing Address - Country:US
Mailing Address - Phone:440-842-7995
Mailing Address - Fax:
Practice Address - Street 1:9999 INDEPENDENCE BLVD
Practice Address - Street 2:
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-4644
Practice Address - Country:US
Practice Address - Phone:440-842-7995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-5108235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAFMedicaid