Provider Demographics
NPI:1659970101
Name:MOZART, KELSI (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:KELSI
Middle Name:
Last Name:MOZART
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 CHERRY PARKE UNIT A
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-4030
Mailing Address - Country:US
Mailing Address - Phone:646-714-8556
Mailing Address - Fax:
Practice Address - Street 1:928 JAYMOR RD STE C-150
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3832
Practice Address - Country:US
Practice Address - Phone:215-330-4116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-25
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL016221235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist