Individual
SHANA KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
25250 N 35TH AVE, PHOENIX, AZ 85083-4335
(623) 445-7100
Mailing address
20402 N 15TH AVE, PHOENIX, AZ 85027-3699
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
TSLP12051
AZ
Other
Enumeration date
08/26/2019
Last updated
08/26/2019
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