Provider Demographics
NPI:1831082585
Name:KOLANOWSKI, KELLY (CCC SLP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:KOLANOWSKI
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19200 NEW HAMPSHIRE AVE
Mailing Address - Street 2:
Mailing Address - City:BRINKLOW
Mailing Address - State:MD
Mailing Address - Zip Code:20862-9730
Mailing Address - Country:US
Mailing Address - Phone:240-480-4394
Mailing Address - Fax:
Practice Address - Street 1:19200 NEW HAMPSHIRE AVE
Practice Address - Street 2:
Practice Address - City:BRINKLOW
Practice Address - State:MD
Practice Address - Zip Code:20862-9730
Practice Address - Country:US
Practice Address - Phone:240-480-4394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11557235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist