Individual
MS. SHANA L KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
4115 UNIVERSITY WAY NE, STE 202, SEATTLE, WA 98105-6257
(206) 299-1780
(206) 524-9836
Mailing address
4115 UNIVERSITY WAY NE, STE 202, SEATTLE, WA 98105-6257
(206) 299-1780
(206) 524-9836
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
LL00003194
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1508829052
CHILDREN'S COMMUNICATION CORNER NPI
WA
01
—
204367673
TAX ID
WA
01
—
6704KE
REGENCE
WA
05
—
7115272
—
WA
Enumeration date
02/02/2007
Last updated
10/28/2014
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