Healthcare Provider Details

I. General information

NPI: 1053256370
Provider Name (Legal Business Name): KELSEY BEEHLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 RICHMOND ST APT 401
SAN DIEGO CA
92103-3791
US

IV. Provider business mailing address

4015 RICHMOND ST APT 401
SAN DIEGO CA
92103-3791
US

V. Phone/Fax

Practice location:
  • Phone: 916-705-0901
  • Fax:
Mailing address:
  • Phone: 916-705-0901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: