Individual
KELLY LY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
328 NORTHBANK CT APT 37, STOCKTON, CA 95207-7611
(209) 323-8655
Mailing address
328 NORTHBANK CT APT 37, STOCKTON, CA 95207-7611
(209) 323-8655
Taxonomy
Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
SPA 727
CA
Other
Enumeration date
01/27/2012
Last updated
01/27/2012
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