Individual
KELLY DECLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
10483 DIXIE HWY, HOLLY, MI 48442-9311
(810) 771-7686
Mailing address
10483 DIXIE HWY, HOLLY, MI 48442-9311
(810) 771-7686
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7152001440
MI
Other
Enumeration date
06/09/2026
Last updated
06/09/2026
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