Provider Demographics
NPI:1962030320
Name:KELSEY, CONSTANCE M (SLP)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:M
Last Name:KELSEY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11040 N STATE ROAD 77
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-3606
Mailing Address - Country:US
Mailing Address - Phone:715-934-4215
Mailing Address - Fax:715-934-5416
Practice Address - Street 1:11040 N STATE ROAD 77
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-3606
Practice Address - Country:US
Practice Address - Phone:715-934-4215
Practice Address - Fax:715-934-5416
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1400-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist