Kelley Bean
Individual provider Active NPI Speech-Language Pathologist · Groton, CT
NPI 1386058766 · NPPES record last updated Nov 3, 2019
Key facts
- NPI
- 1386058766
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 005129 (CT)
- Practice address
- 27 Noble Ave Unit 3
Groton, CT 06340-5624 - Phone
- (413) 265-1813
- NPI assigned
- Jun 13, 2014
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7739 | MA | MD | Speech-Language Pathologist |
| 005129 | CT | MD | Adult Health Nurse Practitioner |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 7739 | MA | |
| Speech-Language Pathologist | 235Z00000X | 005129 | CT | Yes |
Addresses
Primary practice location
27 Noble Ave Unit 3
Groton, CT 06340-5624
Mailing address
27 Noble Ave Unit 3
Groton, CT 06340-5624
Phone (413) 265-1813
Other practice location 1
125 Orange St
Nantucket, MA 02554-4028
Phone (413) 265-1813
Other providers in Groton, CT
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- Rashad Lamar Beamon
- Nicholas David Becker
- Matthew Benjamin
- Frederick William Berggren Jr.
- Andrew James Bergmann
- Peter Paul Bertolozzi Jr.
All providers in Groton, CT · Speech-Language Pathologist in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 3, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.