Provider Demographics
NPI:1538524558
Name:PRICE, KELLY ROSE (MS)
Entity type:Individual
Prefix:MISS
First Name:KELLY
Middle Name:ROSE
Last Name:PRICE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 SE 24TH RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6005
Mailing Address - Country:US
Mailing Address - Phone:352-629-8900
Mailing Address - Fax:
Practice Address - Street 1:35059 SMOKETREE LN
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33523-9405
Practice Address - Country:US
Practice Address - Phone:209-601-0251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist