Provider Demographics
NPI:1275681587
Name:NELSON, KAY ELLEN (CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:KAY
Middle Name:ELLEN
Last Name:NELSON
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:MISS
Other - First Name:KAY
Other - Middle Name:ELLEN
Other - Last Name:LOFGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC SLP
Mailing Address - Street 1:5112 NW TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98312-8837
Mailing Address - Country:US
Mailing Address - Phone:360-373-2536
Mailing Address - Fax:360-373-4934
Practice Address - Street 1:5112 NW TAYLOR RD
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98312-8837
Practice Address - Country:US
Practice Address - Phone:360-373-2536
Practice Address - Fax:360-373-4934
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00002976235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist