Provider Demographics
NPI:1679922850
Name:PHILLIPS, KELSEY (SLP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:SCHIELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:215 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701
Mailing Address - Country:US
Mailing Address - Phone:701-857-4400
Mailing Address - Fax:701-857-4432
Practice Address - Street 1:215 2ND ST SE
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701
Practice Address - Country:US
Practice Address - Phone:701-857-4400
Practice Address - Fax:701-857-4432
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1490235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist