Provider Demographics
NPI:1992313530
Name:KELLY, MEGAN RENEE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:RENEE
Last Name:KELLY
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:RENEE
Other - Last Name:LEDFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:2165 CHATTAHOOCHEE DR
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-7941
Mailing Address - Country:US
Mailing Address - Phone:423-915-6573
Mailing Address - Fax:
Practice Address - Street 1:2165 CHATTAHOOCHEE DR
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-7941
Practice Address - Country:US
Practice Address - Phone:601-654-4912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET003132235Z00000X
GASLP011861235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist