Provider Demographics
NPI:1528639861
Name:DAVIS-SULLIVAN, KELSEY JO (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:JO
Last Name:DAVIS-SULLIVAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1829 DENVER WEST DR BLDG 27
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3120
Mailing Address - Country:US
Mailing Address - Phone:303-982-6500
Mailing Address - Fax:
Practice Address - Street 1:1829 DENVER WEST DR BLDG 27
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-3120
Practice Address - Country:US
Practice Address - Phone:303-982-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSLP.0000827235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist