Provider Demographics
NPI:1427441237
Name:PAUL-CHARLSON, KELSEY ANNE (MS,CCC-SLP)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:ANNE
Last Name:PAUL-CHARLSON
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:ANNE
Other - Last Name:PAUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:6165 NW 86TH ST # 238
Mailing Address - Street 2:
Mailing Address - City:JOHNSTON
Mailing Address - State:IA
Mailing Address - Zip Code:50131-2270
Mailing Address - Country:US
Mailing Address - Phone:515-219-7254
Mailing Address - Fax:515-864-0740
Practice Address - Street 1:6165 NW 86TH ST # 238
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-2270
Practice Address - Country:US
Practice Address - Phone:515-219-7254
Practice Address - Fax:515-864-0740
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-18
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA077378235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist