Provider Demographics
NPI:1548310055
Name:KELLY, ELLEN (MS)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:KELLY
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 1:11 KENSINGTON CT
Mailing Address - Street 2:
Mailing Address - City:ASBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08802-1100
Mailing Address - Country:US
Mailing Address - Phone:908-735-7123
Mailing Address - Fax:
Practice Address - Street 1:44 MILLTOWN RD
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-2356
Practice Address - Country:US
Practice Address - Phone:732-238-1664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter