Provider Demographics
NPI:1942972948
Name:SNOWDEN, KELSEY MARIE
Entity Type:Individual
Prefix:MS
First Name:KELSEY
Middle Name:MARIE
Last Name:SNOWDEN
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 1:3526 E DEPOT RD
Mailing Address - Street 2:
Mailing Address - City:VERMONT
Mailing Address - State:IL
Mailing Address - Zip Code:61484-9640
Mailing Address - Country:US
Mailing Address - Phone:309-255-5256
Mailing Address - Fax:
Practice Address - Street 1:1502 E US HIGHWAY 136
Practice Address - Street 2:
Practice Address - City:TABLE GROVE
Practice Address - State:IL
Practice Address - Zip Code:61482-9612
Practice Address - Country:US
Practice Address - Phone:309-758-5138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist