Provider Demographics
NPI:1215524152
Name:MORIARTY, KELSEA K (MA SLP-CC)
Entity type:Individual
Prefix:
First Name:KELSEA
Middle Name:K
Last Name:MORIARTY
Suffix:
Gender:F
Credentials:MA SLP-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 BRISA DEL MAR
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-9730
Mailing Address - Country:US
Mailing Address - Phone:831-345-8649
Mailing Address - Fax:
Practice Address - Street 1:675 BRISA DEL MAR
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-9730
Practice Address - Country:US
Practice Address - Phone:831-345-8649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-27
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist