Provider Demographics
NPI:1053055913
Name:ABBAS, KELSEY POCHE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:POCHE
Last Name:ABBAS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:NICOLE
Other - Last Name:POCHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9303 SHENANDOAH CIR
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-3743
Mailing Address - Country:US
Mailing Address - Phone:480-236-9882
Mailing Address - Fax:
Practice Address - Street 1:1956 1ST ST
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:LA
Practice Address - Zip Code:71001-3524
Practice Address - Country:US
Practice Address - Phone:318-236-9416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7134235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist