Individual
MR. MATTHEW TODD KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A. CCC-SLP
Contact information
Practice address
1919 5TH ST, SANTA FE, NM 87505-5402
(505) 204-8919
Mailing address
3 PRAIRIE CREST DR, SANTA FE, NM 87508-1314
(505) 204-8919
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
C-4614
NM
Other
Enumeration date
02/25/2010
Last updated
06/16/2016
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