Provider Demographics
NPI:1174040067
Name:CAMPBELL, KELSEY O (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:O
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3718 GARDEN CITY BLVD SE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-5821
Mailing Address - Country:US
Mailing Address - Phone:540-400-5577
Mailing Address - Fax:
Practice Address - Street 1:3718 GARDEN CITY BLVD SE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-5821
Practice Address - Country:US
Practice Address - Phone:540-400-5577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202008543235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist