Basic Information
| Provider Information | |||||||||
| NPI: | 1124399894 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DELLIS | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | BETH | ||||||||
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| Credential: | CCC/SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 MC CREY DR | ||||||||
| Address2: | |||||||||
| City: | BALLSTON SPA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120206000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5188799122 | ||||||||
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| Practice Location | |||||||||
| Address1: | 515 MAPLE AVE | ||||||||
| Address2: | |||||||||
| City: | SARATOGA SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128665504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185874551 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2012 | ||||||||
| LastUpdateDate: | 01/26/2012 | ||||||||
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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 | 01097630 | NY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.