Provider Demographics
NPI:1457474660
Name:KELSO, KATHY M (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:M
Last Name:KELSO
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1826 TEJAS TRL
Mailing Address - Street 2:
Mailing Address - City:DALHART
Mailing Address - State:TX
Mailing Address - Zip Code:79022-5130
Mailing Address - Country:US
Mailing Address - Phone:806-244-3006
Mailing Address - Fax:
Practice Address - Street 1:1411 DENVER AVE
Practice Address - Street 2:
Practice Address - City:DALHART
Practice Address - State:TX
Practice Address - Zip Code:79022-4809
Practice Address - Country:US
Practice Address - Phone:806-244-4571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18582235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist