Provider Demographics
NPI:1558058743
Name:JOSEPH, KELSEY AMANDA (SLP-A)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:AMANDA
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:SLP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10950 JEFFERSON HWY APT H5
Mailing Address - Street 2:
Mailing Address - City:RIVER RIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70123-1733
Mailing Address - Country:US
Mailing Address - Phone:504-432-1315
Mailing Address - Fax:
Practice Address - Street 1:10950 JEFFERSON HWY
Practice Address - Street 2:APT H5
Practice Address - City:RIVER RIDGE
Practice Address - State:LA
Practice Address - Zip Code:70123-7012
Practice Address - Country:US
Practice Address - Phone:504-432-1315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA8033235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty