Provider Demographics
NPI:1427549930
Name:PARAS, KELSEY MAE DADIVAS (CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:KELSEY MAE
Middle Name:DADIVAS
Last Name:PARAS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 REDONDO BEACH BLVD STE C-4
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-1683
Mailing Address - Country:US
Mailing Address - Phone:657-243-0715
Mailing Address - Fax:
Practice Address - Street 1:2100 REDONDO BEACH BLVD STE C-4
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-1683
Practice Address - Country:US
Practice Address - Phone:657-243-0715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-21
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32079235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist