Individual
HEATHER KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2685 LEEDS AVE, NORTH CHARLESTON, SC 29405-6861
(843) 529-3130
Mailing address
1250 WINNOWING WAY UNIT 416, MOUNT PLEASANT, SC 29466-7527
(860) 919-5925
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6554
—
SC
Enumeration date
10/10/2018
Last updated
10/10/2018
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