Provider Demographics
NPI:1861686032
Name:KELSEY, EZEKIEL HANS (SLP)
Entity Type:Individual
Prefix:
First Name:EZEKIEL
Middle Name:HANS
Last Name:KELSEY
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:ZEKE
Other - Middle Name:HANS
Other - Last Name:KELSEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLS
Mailing Address - Street 1:3231 SPRING CREEK DR
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301
Mailing Address - Country:US
Mailing Address - Phone:208-320-5686
Mailing Address - Fax:
Practice Address - Street 1:392 FALLS AVE
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3373
Practice Address - Country:US
Practice Address - Phone:208-749-3475
Practice Address - Fax:208-450-2408
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1643235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1861686032Medicaid