Individual
KELLY ANN REID
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1200 MIRA MAR AVE, MEDFORD, OR 97504-8546
(541) 848-7868
Mailing address
1200 MIRA MAR AVE, MEDFORD, OR 97504-8546
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
11091
OR
Other
Enumeration date
12/10/2018
Last updated
12/10/2018
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