Basic Information
| Provider Information | |||||||||
| NPI: | 1518082767 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WEBB | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | DARLEEN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36 SKYHARBOR DR | ||||||||
| Address2: | |||||||||
| City: | PORT MATILDA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 168708329 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1229 WARM SPRINGS AVE | ||||||||
| Address2: | |||||||||
| City: | HUNTINGDON | ||||||||
| State: | PA | ||||||||
| PostalCode: | 166522350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8146434210 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | SL002560L | PA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.