Provider Demographics
NPI:1386261733
Name:GOUVEIA, KELSEY
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:GOUVEIA
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 1:6180 BROCKTON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2259
Mailing Address - Country:US
Mailing Address - Phone:951-684-6500
Mailing Address - Fax:
Practice Address - Street 1:6180 BROCKTON AVE STE 102
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2259
Practice Address - Country:US
Practice Address - Phone:951-684-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist