Provider Demographics
NPI:1811208093
Name:NIELSEN, KELLI MAE (MS, SLP)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:MAE
Last Name:NIELSEN
Suffix:
Gender:F
Credentials:MS, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1273 MASSMAN DRIVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217
Mailing Address - Country:US
Mailing Address - Phone:615-397-3856
Mailing Address - Fax:
Practice Address - Street 1:1273 MASSMAN DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-1757
Practice Address - Country:US
Practice Address - Phone:615-397-3856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3079235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist