Provider Demographics
NPI:1346804150
Name:BAILEY, KELSEY (SLPA)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 S HORNE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5760
Mailing Address - Country:US
Mailing Address - Phone:480-461-3206
Mailing Address - Fax:
Practice Address - Street 1:1460 S HORNE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5760
Practice Address - Country:US
Practice Address - Phone:480-461-3206
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA104802355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant