Susan Deanne Kelley, M.A., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

104778 Issued in TX

Practice address

4091 Eastchester Dr
Bryan, TX 77802-4735

Phone

(228) 326-7133

Fax

(979) 776-5096

NPI assigned

Dec 30, 2011

Last updated

Jul 9, 2013By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1325203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373328000000",
    "number": "1316217805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 MARION PUGH DR",
            "address_2": "APT 901",
            "city": "COLLEGE STATION",
            "state": "TX",
            "postal_code": "778402746",
            "telephone_number": "228-326-7133",
            "fax_number": "979-776-5096"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4091 EASTCHESTER DR",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778024735",
            "telephone_number": "228-326-7133",
            "fax_number": "979-776-5096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "SUSAN",
        "middle_name": "DEANNE",
        "credential": "M.A., CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-12-30",
        "last_updated": "2013-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "104778",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE TO PRACTICE",
            "identifier": "104778",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ASHA CERTIFICATION NUMBER",
            "identifier": "01030667",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aaron Karp
• Charity A Karpac, MD
• Allison Brooke Katchinska
• Mindi Greene Kavanaugh, OD
• Cheriece Kananimaeole Keawe
• Kelly W Lobb MD PA
• Shauna Kelly, PT
• Shannon Kelsey, NP-C
• Paige Kenjura
• John Kent Jr., CSA

• Speech-Language Pathologist in Bryan, TX
• Providers in Bryan, TX by specialty
• Speech-Language Pathologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2013; 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.