MEDICARE: KELLI MAE NIELSEN MS, 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	3079	TN

General Provider Information

NPI Number	:	1811208093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI MAE NIELSEN MS, SLP

Provider Business Mailing Address
First Line	:	1273 MASSMAN DRIVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37217
Country	:	US
Telephone Number	:	615-397-3856
Fax Number	:

Provider Business Practice Location Address
First Line	:	1273 MASSMAN DR
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37217-1757
Country	:	US
Telephone Number	:	615-397-3856
Fax Number	:

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

Provider Enumeration Date	:	06/23/2010
Last Update Date	:	06/23/2010

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