Provider Demographics
NPI:1518356641
Name:SHANLEY, KELSA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELSA
Middle Name:
Last Name:SHANLEY
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:CALL BOX A
Mailing Address - Street 2:SAUGERTIES SCHOOL DISTRICT
Mailing Address - City:SAUGERTIES
Mailing Address - State:NY
Mailing Address - Zip Code:12477
Mailing Address - Country:US
Mailing Address - Phone:845-247-6500
Mailing Address - Fax:
Practice Address - Street 1:70 PLENTY ST.
Practice Address - Street 2:
Practice Address - City:GLASCO
Practice Address - State:NY
Practice Address - Zip Code:12432
Practice Address - Country:US
Practice Address - Phone:845-247-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist