Provider Demographics
NPI:1366127557
Name:BRYANT, KELSEY J (SLP)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:J
Last Name:BRYANT
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11315 MCCORMICK RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-9512
Mailing Address - Country:US
Mailing Address - Phone:901-461-7693
Mailing Address - Fax:901-867-1603
Practice Address - Street 1:1751 DANCY BLVD
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637-1916
Practice Address - Country:US
Practice Address - Phone:901-461-7633
Practice Address - Fax:901-867-1603
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS-5079235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty