Individual
KELLY BOWES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2821 NESTLING RD, PHILADELPHIA, PA 19154-1609
(267) 808-4796
Mailing address
2821 NESTLING RD, PHILADELPHIA, PA 19154-1609
(267) 808-4796
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SL009025
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LL60486309
SPEECH LANGUAGE PATHOLOGY LICENSE
WA
01
—
SL009025
SPEECH LANGUAGE PATHOLOGY LICENSE
PA
01
—
SP 22170
SPEECH LANGUAGE PATHOLOGY LICENSE
CA
Enumeration date
07/26/2015
Last updated
07/26/2015
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