Individual
MRS. KELLEY MARIE EDELBROCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A. CCC-SLP
Contact information
Practice address
14700 HORSESHOE BEND CT, GRANGER, IN 46530-8269
(574) 271-9079
Mailing address
14700 HORSESHOE BEND CT, GRANGER, IN 46530-8269
(574) 271-9079
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22001967A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200655050
FIRST STEPS-
IN
01
—
200718460
FIRST STEPS PROVIDOR #
IN
Enumeration date
05/22/2007
Last updated
07/08/2007
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