Provider Demographics
NPI:1790294833
Name:MCINTYRE, KELSEY MARIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:MARIE
Last Name:MCINTYRE
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 1:1702 LINDEN WAY
Mailing Address - Street 2:
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3238
Mailing Address - Country:US
Mailing Address - Phone:267-981-3418
Mailing Address - Fax:
Practice Address - Street 1:4603 JOHN GARRY DR STE 10
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-6834
Practice Address - Country:US
Practice Address - Phone:573-777-8783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017033847235Z00000X
PASL015284235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist