Provider Demographics
NPI:1548553381
Name:MCNAMARA, KELLI (MS/CCC-SLP)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MEADOW LKS
Mailing Address - Street 2:
Mailing Address - City:HIGHTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-4804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 MEADOW LKS
Practice Address - Street 2:
Practice Address - City:HIGHTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08520-4804
Practice Address - Country:US
Practice Address - Phone:609-426-6818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS0065900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist