Provider Demographics
NPI:1295983187
Name:STARR, KELLY NICHOLS (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:NICHOLS
Last Name:STARR
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ELIZABETH
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:475 MARKET PL
Mailing Address - Street 2:BUILDING 1, SUITE A
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-1649
Mailing Address - Country:US
Mailing Address - Phone:734-998-8119
Mailing Address - Fax:
Practice Address - Street 1:475 MARKET PL
Practice Address - Street 2:BUILDING 1, SUITE A
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-1649
Practice Address - Country:US
Practice Address - Phone:734-998-8119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist