Provider Demographics
NPI:1003155573
Name:MATTSON, KELSEY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:MATTSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:IL
Mailing Address - Zip Code:60531-0336
Mailing Address - Country:US
Mailing Address - Phone:815-970-5458
Mailing Address - Fax:
Practice Address - Street 1:200 W LUNDY LN
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:IL
Practice Address - Zip Code:60531-3130
Practice Address - Country:US
Practice Address - Phone:815-970-5458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist