Provider Demographics
NPI:1407311186
Name:KELSO, ABBY (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ABBY
Middle Name:
Last Name:KELSO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 CHOCTAW TRL
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1573
Mailing Address - Country:US
Mailing Address - Phone:214-949-0373
Mailing Address - Fax:
Practice Address - Street 1:102 YMCA DR STE E
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-5123
Practice Address - Country:US
Practice Address - Phone:214-949-0373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111717235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist