Provider Demographics
NPI:1306109566
Name:KELLEY, PATRICIA A (HIS)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:KELLEY
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HIS
Mailing Address - Street 1:215 SHUMAN BLVD
Mailing Address - Street 2:STE 401
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8458
Mailing Address - Country:US
Mailing Address - Phone:331-229-8208
Mailing Address - Fax:978-313-6824
Practice Address - Street 1:3925 ROOSEVELT BLVD
Practice Address - Street 2:STE C
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45044-6692
Practice Address - Country:US
Practice Address - Phone:513-424-7006
Practice Address - Fax:513-785-4023
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02829237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist