Provider Demographics
NPI:1083199202
Name:ROSE, KELSEY LEE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:LEE
Last Name:ROSE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:KELSEY
Other - Middle Name:LEE
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:KELSEY SMITH
Mailing Address - Street 1:145 STEFFEE BLVD
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-3035
Mailing Address - Country:US
Mailing Address - Phone:814-677-1390
Mailing Address - Fax:814-677-1393
Practice Address - Street 1:145 STEFFEE BLVD
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:PA
Practice Address - Zip Code:16346-3035
Practice Address - Country:US
Practice Address - Phone:814-677-1390
Practice Address - Fax:814-677-1393
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-03
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.13268235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASL014434OtherSTATE LICENSE