Provider Demographics
NPI:1285250027
Name:MCCALLUM, KELSEY SHAKE (SLP)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:SHAKE
Last Name:MCCALLUM
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:LAUREN
Other - Last Name:SHAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:540 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-3931
Mailing Address - Country:US
Mailing Address - Phone:972-974-7576
Mailing Address - Fax:
Practice Address - Street 1:4778 OVERTON RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35210-3803
Practice Address - Country:US
Practice Address - Phone:205-957-0294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4137235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist