Provider Demographics
NPI:1033705587
Name:ROWELL, KELSEY BAZZELL (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:BAZZELL
Last Name:ROWELL
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7709 TAMPA WAY
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5701
Mailing Address - Country:US
Mailing Address - Phone:318-415-9298
Mailing Address - Fax:
Practice Address - Street 1:7709 TAMPA WAY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5701
Practice Address - Country:US
Practice Address - Phone:318-415-9298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7682235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist