Provider Demographics
NPI:1912654252
Name:BRONSON, KELSEY JO (MS,SLP-CFY)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:JO
Last Name:BRONSON
Suffix:
Gender:F
Credentials:MS,SLP-CFY
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:JO
Other - Last Name:ARMSTRONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,SLP-CFY
Mailing Address - Street 1:90 HOWARD DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8138
Mailing Address - Country:US
Mailing Address - Phone:502-633-1007
Mailing Address - Fax:
Practice Address - Street 1:1608 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2387
Practice Address - Country:US
Practice Address - Phone:615-614-8833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7558235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist