Provider Demographics
NPI:1407995251
Name:BAUCOM, KELSEY JEAN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:JEAN
Last Name:BAUCOM
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 1:1014 DURWARD HALL DR
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-3203
Mailing Address - Country:US
Mailing Address - Phone:417-793-1490
Mailing Address - Fax:
Practice Address - Street 1:1014 DURWARD HALL DR
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-3203
Practice Address - Country:US
Practice Address - Phone:417-793-1490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006013845235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist