Provider Demographics
NPI:1972977577
Name:MILLER, KELSEY ANN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:KELSEY
Other - Middle Name:ANN
Other - Last Name:JOHNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 SECOND STREET WSD SPECIAL SERVICES
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98674
Mailing Address - Country:US
Mailing Address - Phone:360-841-2770
Mailing Address - Fax:360-841-2720
Practice Address - Street 1:800 SECOND STREET WSD SPECIAL SERVICE
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:WA
Practice Address - Zip Code:98674
Practice Address - Country:US
Practice Address - Phone:360-841-2770
Practice Address - Fax:136-084-1272
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60570141235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist