Individual
BEVERLY DIANE KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP-CCC
Contact information
Practice address
1580 HIGHWAY 51 S, COVINGTON, TN 38019-3221
(423) 622-1551
Mailing address
PO BOX 8114, CHATTANOOGA, TN 37414-0114
(423) 622-1551
(877) 856-7133
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1216
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1216
TN HEALTH LICENSE
TN
Enumeration date
11/23/2019
Last updated
11/23/2019
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