Provider Demographics
NPI:1043661283
Name:LAMB, KELLSIE JEAN (MA)
Entity Type:Individual
Prefix:
First Name:KELLSIE
Middle Name:JEAN
Last Name:LAMB
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3689 EWINGS RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-1028
Mailing Address - Country:US
Mailing Address - Phone:716-535-0806
Mailing Address - Fax:
Practice Address - Street 1:51 HIGH ST
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-4333
Practice Address - Country:US
Practice Address - Phone:716-478-4750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-29
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist