Provider Demographics
NPI:1720537269
Name:WENDLAND, KELSEY ANN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:ANN
Last Name:WENDLAND
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 LITTLE LAKE DR STE 4
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-6219
Mailing Address - Country:US
Mailing Address - Phone:224-305-3024
Mailing Address - Fax:
Practice Address - Street 1:180 LITTLE LAKE DR STE 4
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-6219
Practice Address - Country:US
Practice Address - Phone:224-305-3024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101007956235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist