Healthcare Provider Details

I. General information

NPI: 1225964307
Provider Name (Legal Business Name): KELSEY SUEANN WILSON SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 REMINGTON CV
LITTLE ROCK AR
72204-8274
US

IV. Provider business mailing address

5 REMINGTON CV
LITTLE ROCK AR
72204-8274
US

V. Phone/Fax

Practice location:
  • Phone: 501-850-8788
  • Fax: 501-850-8791
Mailing address:
  • Phone: 501-850-8788
  • Fax: 501-850-8791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number203520
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: