MEDICARE: KELSEY ELLEN CASE M.S., CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	4674	OK

General Provider Information

NPI Number	:	1629639687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY ELLEN CASE M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	1117 S DOUGLAS BLVD STE F
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-5265
Country	:	US
Telephone Number	:	405-368-6751
Fax Number	:

Provider Business Practice Location Address
First Line	:	1117 S DOUGLAS BLVD STE F
Second Line	:
City	:	MIDWEST CITY
State	:	OK
Zip	:	73130-5265
Country	:	US
Telephone Number	:	405-368-6751
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2019
Last Update Date	:	05/27/2026

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Directions to “ KELSEY ELLEN CASE M.S., CCC-SLP” Practice Location

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