Provider Demographics
NPI:1942612221
Name:BUTTERFIELD, KELSIE RAE
Entity Type:Individual
Prefix:
First Name:KELSIE
Middle Name:RAE
Last Name:BUTTERFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2166 MARTIN CREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-2504
Mailing Address - Country:US
Mailing Address - Phone:330-605-8092
Mailing Address - Fax:
Practice Address - Street 1:4515 22ND STREET NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-1557
Practice Address - Country:US
Practice Address - Phone:877-927-4841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2014211235Z00000X
OH11613235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist