Basic Information
| Provider Information | |||||||||
| NPI: | 1063929040 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLINE | ||||||||
| FirstName: | KELLY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 OAK HILL LN APT 112 | ||||||||
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| City: | NASHUA | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030624635 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 21 SEARLES RD | ||||||||
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| City: | WINDHAM | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030871203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038901290 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2017 | ||||||||
| LastUpdateDate: | 12/29/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.