Provider Demographics
NPI:1225441553
Name:MANGREM, KELSI DEE (AUD)
Entity Type:Individual
Prefix:DR
First Name:KELSI
Middle Name:DEE
Last Name:MANGREM
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MS
Other - First Name:KELSI
Other - Middle Name:DEE
Other - Last Name:LEARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5269
Mailing Address - Country:US
Mailing Address - Phone:325-437-4730
Mailing Address - Fax:
Practice Address - Street 1:7 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5269
Practice Address - Country:US
Practice Address - Phone:325-437-4730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80588231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist