Healthcare Provider Details

I. General information

NPI: 1467007245
Provider Name (Legal Business Name): KELSEY HUDGINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSEY FISHER

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20033 N 19TH AVE
PHOENIX AZ
85027-4245
US

IV. Provider business mailing address

41134 N CAMBRIA DR
SAN TAN VALLEY AZ
85140-3172
US

V. Phone/Fax

Practice location:
  • Phone: 480-875-5616
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP16163
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: