Provider Demographics
NPI:1548491012
Name:GRIEST, KELLEY (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KELLEY
Middle Name:
Last Name:GRIEST
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:KELLEY
Other - Middle Name:LYNN
Other - Last Name:YANES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:1970 JOSEPH DRIVE
Mailing Address - Street 2:
Mailing Address - City:MORAGA
Mailing Address - State:CA
Mailing Address - Zip Code:94556-2713
Mailing Address - Country:US
Mailing Address - Phone:925-631-0667
Mailing Address - Fax:925-631-0495
Practice Address - Street 1:1970 JOSEPH DR
Practice Address - Street 2:
Practice Address - City:MORAGA
Practice Address - State:CA
Practice Address - Zip Code:94556-2713
Practice Address - Country:US
Practice Address - Phone:925-631-0667
Practice Address - Fax:925-631-0495
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-01
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17440235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist