Provider Demographics
NPI:1346982006
Name:WALLEN, KELSEY LEANNE (MS-CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:LEANNE
Last Name:WALLEN
Suffix:
Gender:F
Credentials:MS-CCC-SLP
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:LEANNE WALLEN
Other - Last Name:NEWMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS-CCC-SLP
Mailing Address - Street 1:1017 N DEMAREE ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-4117
Mailing Address - Country:US
Mailing Address - Phone:559-741-9687
Mailing Address - Fax:559-741-9694
Practice Address - Street 1:1017 N DEMAREE ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4117
Practice Address - Country:US
Practice Address - Phone:559-741-9687
Practice Address - Fax:559-741-9694
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29090235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist