Provider Demographics
NPI:1285207746
Name:RANDLE, KELSEY ELAINE
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:ELAINE
Last Name:RANDLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4908 LONGBOW DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-5113
Mailing Address - Country:US
Mailing Address - Phone:573-819-4339
Mailing Address - Fax:
Practice Address - Street 1:5275 REDTAIL DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MO
Practice Address - Zip Code:65010-2102
Practice Address - Country:US
Practice Address - Phone:573-657-2147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist