Provider Demographics
NPI:1306289806
Name:CHILDERS, KELSIE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KELSIE
Middle Name:
Last Name:CHILDERS
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 1:13102 S 600 E
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:IN
Mailing Address - Zip Code:46919
Mailing Address - Country:US
Mailing Address - Phone:574-361-6298
Mailing Address - Fax:
Practice Address - Street 1:13102 S 600 E
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:IN
Practice Address - Zip Code:46919
Practice Address - Country:US
Practice Address - Phone:574-361-6298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-15
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004205A235Z00000X
IN22005920A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist