Provider Demographics
NPI:1760157416
Name:LANHAM, KELSEY (MAT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:LANHAM
Suffix:
Gender:F
Credentials:MAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4733 N TALMAN AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-2993
Mailing Address - Country:US
Mailing Address - Phone:574-220-1194
Mailing Address - Fax:
Practice Address - Street 1:4733 N TALMAN AVE FL 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-2993
Practice Address - Country:US
Practice Address - Phone:574-222-1194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-14
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist