Provider Demographics
NPI:1235692633
Name:KELSCH, PAIGE NICOLE (AUD)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:NICOLE
Last Name:KELSCH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9002 N MERIDIAN ST STE 222
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5350
Mailing Address - Country:US
Mailing Address - Phone:317-844-7059
Mailing Address - Fax:317-819-0044
Practice Address - Street 1:5255 E STOP 11 RD STE 400
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-6341
Practice Address - Country:US
Practice Address - Phone:317-844-7059
Practice Address - Fax:317-819-4516
Is Sole Proprietor?:No
Enumeration Date:2019-04-11
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002765A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCPENDINGMedicaid