Kelly Jo Premo, MS CCC SLP is a
Early Intervention Provider Agency based in Ballston Lake, New York. Kelly Jo Premo is licensed to practice in New York (license number 022776-1) and her current practice location is
118 Westside Dr, Ballston Lake, New York. She can be reached at her office (for appointments etc.) via phone at
(518) 424-7971.
NPI number for Kelly Jo Premo is 1891117990 and her current mailing address is 118 Westside Dr, Ballston Lake, New York. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1891117990.
Healthcare Provider's Profile
| Full Name | Kelly Jo Premo |
|---|
| Gender | Female |
|---|
| Speciality | Early Intervention Provider Agency |
|---|
| Location | 118 Westside Dr, Ballston Lake, New York |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1891117990
- Provider Enumeration Date: 01/09/2014
- Last Update Date: 04/14/2020
Medical Identifiers
Medical identifiers for Kelly Jo Premo such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1891117990 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 235Z00000X | Speech-language Pathologist | 022776-1 (New York) | Secondary |
| 252Y00000X | Early Intervention Provider Agency | 022776-1 (New York) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kelly Jo Premo is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Kelly Jo Premo, MS CCC SLP
118 Westside Dr,
Ballston Lake, NY 12019-2028
Ph: (518) 424-7971 | Kelly Jo Premo, MS CCC SLP
118 Westside Dr,
Ballston Lake, NY 12019-2028
Ph: (518) 424-7971 |
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