MEDICARE: KELSEY MARIE MCINTYRE 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	2017033847	MO
2	235Z00000X	Speech-Language Pathologist	SL015284	PA

General Provider Information

NPI Number	:	1790294833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY MARIE MCINTYRE CCC-SLP

Provider Business Mailing Address
First Line	:	1702 LINDEN WAY
Second Line	:
City	:	KING OF PRUSSIA
State	:	PA
Zip	:	19406-3238
Country	:	US
Telephone Number	:	267-981-3418
Fax Number	:

Provider Business Practice Location Address
First Line	:	4603 JOHN GARRY DR STE 10
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-6834
Country	:	US
Telephone Number	:	573-777-8783
Fax Number	:

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

Provider Enumeration Date	:	09/20/2017
Last Update Date	:	08/13/2020

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Directions to “ KELSEY MARIE MCINTYRE CCC-SLP” Practice Location

Language	Start Address	Practice Location

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