Active NPI
Kelly Ly
- Speech-Language Assistant
- Stockton, CA
National Provider Identifier
1073885745
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Assistant
- License
- SPA 727
- Practice address
- 328 Northbank CT Apt 37
Stockton, CA 95207-7611 - Phone
- (209) 323-8655
- NPI assigned
- Jan 27, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Assistant | 2355S0801X | SPA 727 | CA | Primary |
Addresses
Primary practice location
328 Northbank CT Apt 37
Stockton, CA 95207-7611
Mailing address
328 Northbank CT Apt 37
Stockton, CA 95207-7611
Phone (209) 323-8655
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SPA 727 | CA | MD | Speech-Language Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1327622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1327622400000",
"number": "1073885745",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "328 NORTHBANK CT APT 37",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952077611",
"telephone_number": "209-323-8655"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "328 NORTHBANK CT APT 37",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952077611",
"telephone_number": "209-323-8655"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LY",
"first_name": "KELLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-01-27",
"last_updated": "2012-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "2355S0801X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Speech-Language Assistant",
"state": "CA",
"license": "SPA 727",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.