Individual
KELLY MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
2124 16TH ST, BOULDER, CO 80302-4354
(530) 230-7429
Mailing address
2124 16TH ST, BOULDER, CO 80302-4354
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
15946
CA
Other
Enumeration date
09/10/2009
Last updated
08/06/2011
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