Provider Demographics
NPI:1235565748
Name:MOREHEAD, KELSEY LEIGH (SLP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:LEIGH
Last Name:MOREHEAD
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CACHE RIVER RD
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-6360
Mailing Address - Country:US
Mailing Address - Phone:501-773-1419
Mailing Address - Fax:
Practice Address - Street 1:17706 I 30 STE 3
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-2930
Practice Address - Country:US
Practice Address - Phone:501-773-1419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3817235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist