Individual
DR. KELLY MICHELLE VANWYCK-SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP.D., CCC
Contact information
Practice address
2520 RIVERSIDE DR, MACON, GA 31204-1571
(478) 745-9200
Mailing address
165 ORCHARD RIDGE DR, FORSYTH, GA 31029-2685
(478) 745-9200
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
004211
GA
Other
Enumeration date
12/22/2006
Last updated
07/08/2007
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