Michelle Kelly, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

41YS00654800 Issued in NJ

Practice address

85 Godwin Ave
Midland Park, NJ 07432-1970

Phone

(201) 639-8870

Fax

(201) 639-8874

NPI assigned

Jul 31, 2014

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ivyrehab Network Inc.

  • Physical Therapist
  • Hoboken, NJ
  • NPI 1174577274

  Speech-Language Pathologist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1406764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617062400000",
    "number": "1053729202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1377 MOTOR PKWY STE 307",
            "city": "ISLANDIA",
            "state": "NY",
            "postal_code": "117495258",
            "telephone_number": "631-580-5200",
            "fax_number": "631-760-8306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 GODWIN AVE",
            "city": "MIDLAND PARK",
            "state": "NJ",
            "postal_code": "074321970",
            "telephone_number": "201-639-8870",
            "fax_number": "201-639-8874"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "79 Lloyd Rd",
            "address_purpose": "LOCATION",
            "city": "Ho Ho Kus",
            "state": "NJ",
            "postal_code": "074231549",
            "country_code": "US",
            "telephone_number": "201-788-1246",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLY",
        "first_name": "MICHELLE",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-31",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NJ",
            "license": "41YS00654800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Harry Katz, MD
• Alexis Kawalec, OTR/L
• Michelle Kearney, LCSW
• Keith Seidenberg, MD LLC
• Dylan Kelczewski, SLP
• Nancy A Kelly, OTR
• KH Therapy
• Chiyon Kim
• Marla Klein
• C. Michael Knee, M.D.

• Speech-Language Pathologist in Midland Park, NJ
• Providers in Midland Park, NJ by specialty
• Speech-Language Pathologist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.