Provider Demographics
NPI:1699983080
Name:KELLY, JOANN LINDA (MS CCC)
Entity type:Individual
Prefix:MISS
First Name:JOANN
Middle Name:LINDA
Last Name:KELLY
Suffix:
Gender:F
Credentials:MS CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 986
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03818-0986
Mailing Address - Country:US
Mailing Address - Phone:603-447-6356
Mailing Address - Fax:603-447-1114
Practice Address - Street 1:182 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:NH
Practice Address - Zip Code:03818-6140
Practice Address - Country:US
Practice Address - Phone:603-447-6356
Practice Address - Fax:603-447-1114
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0421235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist