Provider Demographics
NPI:1598199200
Name:KEIL, KELSEY (SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:
Last Name:KEIL
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:MCLAUCHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:14425 N 28TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4956
Mailing Address - Country:US
Mailing Address - Phone:509-991-6465
Mailing Address - Fax:
Practice Address - Street 1:14425 N 28TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4956
Practice Address - Country:US
Practice Address - Phone:509-991-6465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP8351235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ847239Medicaid