Provider Demographics
NPI:1588384788
Name:KELLY, KARA DANIELLE (MA, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KARA
Middle Name:DANIELLE
Last Name:KELLY
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 1:115 SUDBROOK LN STE A
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4184
Mailing Address - Country:US
Mailing Address - Phone:443-918-5575
Mailing Address - Fax:
Practice Address - Street 1:1416 LOSSON RD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-4615
Practice Address - Country:US
Practice Address - Phone:607-216-7608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-30
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10752235Z00000X
NY033256235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist