Provider Demographics
NPI:1053563395
Name:KELLY, DOROTHY ANN (SLP)
Entity type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:ANN
Last Name:KELLY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 LIVINGSTON AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:DOBBS FERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522-2826
Mailing Address - Country:US
Mailing Address - Phone:914-231-5014
Mailing Address - Fax:
Practice Address - Street 1:63 LIVINGSTON AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-2826
Practice Address - Country:US
Practice Address - Phone:914-231-5014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000668-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYKELO769Medicaid
NYKELO769Medicare PIN