Provider Demographics
NPI:1154040129
Name:OWENS, KELSEA C (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:KELSEA
Middle Name:C
Last Name:OWENS
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:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:FALLS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78113-0399
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:700 N NELSON ST
Practice Address - Street 2:
Practice Address - City:FALLS CITY
Practice Address - State:TX
Practice Address - Zip Code:78113-6113
Practice Address - Country:US
Practice Address - Phone:830-254-3551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107244235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist