Active NPI
Kelly Leigh Vitug, MS CCC-SLP
- Speech-Language Pathologist
- Gainesville, GA
National Provider Identifier
1699025767
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SLP007702
- Practice address
- 3490 Joe Chandler Rd
Gainesville, GA 30507-7748 - Phone
- (770) 540-7253
- NPI assigned
- Sep 14, 2012
- Sex
- Female
- Sole proprietor
- Yes
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 Pathologist | 235Z00000X | SLP007702 | GA | Primary |
Addresses
Primary practice location
3490 Joe Chandler Rd
Gainesville, GA 30507-7748
Mailing address
3490 Joe Chandler Road
Gainesville, GA 30507
Phone (770) 540-7253
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP007702 | GA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347580800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347580800000",
"number": "1699025767",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3490 JOE CHANDLER ROAD",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "30507",
"telephone_number": "770-540-7253"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3490 JOE CHANDLER RD",
"city": "GAINESVILLE",
"state": "GA",
"postal_code": "305077748",
"telephone_number": "770-540-7253"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VITUG",
"first_name": "KELLY",
"middle_name": "LEIGH",
"credential": "MS CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-09-14",
"last_updated": "2012-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "GA",
"license": "SLP007702",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 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.