Provider Demographics
NPI:1518485580
Name:MEEKER, KELSI NOEL
Entity Type:Individual
Prefix:
First Name:KELSI
Middle Name:NOEL
Last Name:MEEKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELSI
Other - Middle Name:NOEL
Other - Last Name:UBBENGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23057 ARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:IL
Mailing Address - Zip Code:61734-1540
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:208 N WEST AVE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IL
Practice Address - Zip Code:62664-1066
Practice Address - Country:US
Practice Address - Phone:217-482-3269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242004466235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL242004466OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION