Provider Demographics
NPI:1780214932
Name:KELSEY DUNKIN
Entity Type:Organization
Organization Name:KELSEY DUNKIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:707-755-1650
Mailing Address - Street 1:3831 BELLEAU WOOD DR APT 41
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-1879
Mailing Address - Country:US
Mailing Address - Phone:707-755-1650
Mailing Address - Fax:
Practice Address - Street 1:3831 BELLEAU WOOD DR APT 41
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-1879
Practice Address - Country:US
Practice Address - Phone:707-755-1650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency