Provider Demographics
NPI:1245983196
Name:KELLEY, CAITLIN (CCC-SLP)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:
Other - Last Name:KEEF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3659 IRON LACE DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2342
Mailing Address - Country:US
Mailing Address - Phone:606-584-0375
Mailing Address - Fax:
Practice Address - Street 1:4251 SARON DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-7005
Practice Address - Country:US
Practice Address - Phone:606-574-0375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY264339235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist