Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
KELLY JO PREMO, M.S. CCC SLP
Active Sole ProprietorKELLY JO PREMO, M.S. CCC SLP is a Early Intervention Provider Agency healthcare provider located in BALLSTON LAKE, New York. NPI 1891117990 is currently active in the NPPES registry. Verify at CMS.
Early Intervention Provider Agency · BALLSTON LAKE, NY
Registration Details
- NPI Number
- 1891117990
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Jan 9, 2014 (12.41318830185 yrs)
- Last Updated
- Apr 14, 2020
- Licenses
-
022776-1 (NY)022776-1 (NY)
- Sole Proprietor
- Yes
Practice Information
- Address
-
118 WESTSIDE DRBALLSTON LAKE, NY, 120192028Browse NY providers · Browse ZIP 12019
- Phone
- 5184247971
- Primary Specialty
-
Early Intervention Provider Agency
252Y00000X
- Additional Specialty
- Early Intervention Provider Agency
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.