Provider Demographics
NPI:1003579749
Name:BANEY, KELSEY (AUD)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:BANEY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20520 VENTURA BLVD APT 109
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-6215
Mailing Address - Country:US
Mailing Address - Phone:317-319-6050
Mailing Address - Fax:
Practice Address - Street 1:1131 WILSHIRE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-2065
Practice Address - Country:US
Practice Address - Phone:310-825-5721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3613237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter