Individual
JANA KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1000 LAKESHORE ST, GLENWOOD, AR 71943-9127
(870) 356-3206
Mailing address
139 SCOTTLAND LN, BISMARCK, AR 71929-7271
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
131122721
—
AR
Enumeration date
07/02/2008
Last updated
07/02/2008
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