Provider Demographics
NPI:1154069706
Name:AURAND DE RAZO, KELSEY (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:AURAND DE RAZO
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:PO BOX 589
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-0589
Mailing Address - Country:US
Mailing Address - Phone:660-785-0500
Mailing Address - Fax:
Practice Address - Street 1:203 PARK PLZ
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-1969
Practice Address - Country:US
Practice Address - Phone:660-785-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015037212235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2015037212OtherDIVISION OF PROFESSIONAL REGISTRATION
14053535OtherAMERICAN SPEECH-LANGUAGE-HEARING ASSOCIATION