Provider Demographics
NPI:1881303568
Name:KILLEEN, KELSEY ELIZABETH (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KELSEY
Middle Name:ELIZABETH
Last Name:KILLEEN
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 1:2 WATERVIEW RD APT J05
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-6360
Mailing Address - Country:US
Mailing Address - Phone:570-309-1244
Mailing Address - Fax:
Practice Address - Street 1:2 WATERVIEW RD APT J05
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-6360
Practice Address - Country:US
Practice Address - Phone:570-309-1244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL016407235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist