Provider Demographics
NPI:1780155804
Name:COTTOM, KELSEY DAWN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:DAWN
Last Name:COTTOM
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 1:49987 S 36280 RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OK
Mailing Address - Zip Code:74020-6960
Mailing Address - Country:US
Mailing Address - Phone:918-284-0319
Mailing Address - Fax:
Practice Address - Street 1:600 N GILBERT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OK
Practice Address - Zip Code:74020-1023
Practice Address - Country:US
Practice Address - Phone:918-284-0319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist