Provider Demographics
NPI:1114475936
Name:LEE, KELSEY (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 HELEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHAFFEE
Mailing Address - State:MO
Mailing Address - Zip Code:63740-1112
Mailing Address - Country:US
Mailing Address - Phone:573-318-0139
Mailing Address - Fax:
Practice Address - Street 1:1910 WHITENER ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-5239
Practice Address - Country:US
Practice Address - Phone:573-339-1201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016032961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist