Provider Demographics
NPI:1356770903
Name:BATEMAN, KELSIE
Entity type:Individual
Prefix:
First Name:KELSIE
Middle Name:
Last Name:BATEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELSIE
Other - Middle Name:
Other - Last Name:WILDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10601 S 72ND ST STE 103
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-3408
Mailing Address - Country:US
Mailing Address - Phone:402-932-2782
Mailing Address - Fax:402-932-2705
Practice Address - Street 1:10601 S 72ND ST STE 103
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-3408
Practice Address - Country:US
Practice Address - Phone:402-932-2782
Practice Address - Fax:402-932-2705
Is Sole Proprietor?:No
Enumeration Date:2013-11-04
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2013007332235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist