Provider Demographics
NPI:1538902184
Name:KELLY, REBECCA SYRE (AUD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SYRE
Last Name:KELLY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:SYRE
Other - Last Name:HIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1700 KINGFISHER DR STE 27
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-4771
Mailing Address - Country:US
Mailing Address - Phone:301-846-0222
Mailing Address - Fax:301-846-7707
Practice Address - Street 1:1700 KINGFISHER DR STE 27
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-4771
Practice Address - Country:US
Practice Address - Phone:301-846-0222
Practice Address - Fax:301-846-7707
Is Sole Proprietor?:No
Enumeration Date:2024-06-13
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01677231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist