Provider Demographics
NPI:1700901758
Name:RUNNELS, KELSEY LEE (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:LEE
Last Name:RUNNELS
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:MISS
Other - First Name:KELSEY
Other - Middle Name:LEE
Other - Last Name:SHANNON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:98 MOREY AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-5423
Mailing Address - Country:US
Mailing Address - Phone:360-671-3660
Mailing Address - Fax:360-650-9411
Practice Address - Street 1:2001 H ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-3226
Practice Address - Country:US
Practice Address - Phone:360-650-3660
Practice Address - Fax:360-650-9411
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00004186235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist