Provider Demographics
NPI:1194494120
Name:KOELSCH, ELIZABETH MICHELE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MICHELE
Last Name:KOELSCH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1689 SANIBEL DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33896-5659
Mailing Address - Country:US
Mailing Address - Phone:954-253-9684
Mailing Address - Fax:
Practice Address - Street 1:427 BURNS AVE
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-3314
Practice Address - Country:US
Practice Address - Phone:863-679-3338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA19333235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist