Kelly Ann Fagan, CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Greenville, NY
NPI 1659516623 · NPPES record last updated Dec 4, 2008
Key facts
- NPI
- 1659516623
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 008897 (NY)
- Practice address
- 2352 County Route 41
Greenville, NY 12083-4626 - Phone
- (518) 966-5447
- Fax
- (518) 966-5447
- NPI assigned
- Dec 4, 2008
- 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)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 008897 | NY | Yes |
Addresses
Primary practice location
2352 County Route 41
Greenville, NY 12083-4626
Mailing address
2352 County Route 41
Greenville, NY 12083-4626
Phone (518) 966-5447
Other providers in Greenville, NY
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All providers in Greenville, NY · Speech-Language Pathologist in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 4, 2008. 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.