Provider Demographics
NPI:1134603954
Name:HEISSERER, KELSEY ERIN (MA, CF-SLP)
Entity type:Individual
Prefix:MISS
First Name:KELSEY
Middle Name:ERIN
Last Name:HEISSERER
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 SHERWOOD OAKS CT
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3739
Mailing Address - Country:US
Mailing Address - Phone:636-357-5784
Mailing Address - Fax:
Practice Address - Street 1:8970 MEXICO RD
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-7505
Practice Address - Country:US
Practice Address - Phone:636-980-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018034188235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist