Provider Demographics
NPI:1053842179
Name:ARELLANO, KELLY MICHELLE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MICHELLE
Last Name:ARELLANO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:MICHELLE
Other - Last Name:IBANEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:8399 TOPANGA CANYON BLVD STE 309
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91304-2355
Mailing Address - Country:US
Mailing Address - Phone:818-697-1250
Mailing Address - Fax:818-350-3953
Practice Address - Street 1:8399 TOPANGA CANYON BLVD STE 309
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91304-2355
Practice Address - Country:US
Practice Address - Phone:818-697-1250
Practice Address - Fax:818-350-3953
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25321235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist