Provider Demographics
NPI:1043982135
Name:BURKE, KELSEY (MS CF-SLP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 MANN HILL RD APT B
Mailing Address - Street 2:
Mailing Address - City:TIOGA
Mailing Address - State:PA
Mailing Address - Zip Code:16946-8609
Mailing Address - Country:US
Mailing Address - Phone:585-397-4079
Mailing Address - Fax:
Practice Address - Street 1:1883 SHUMWAY HILL RD
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-6840
Practice Address - Country:US
Practice Address - Phone:585-397-4079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist