Healthcare Provider Details

I. General information

NPI: 1619702859
Provider Name (Legal Business Name): KELSIE CLIFTON SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5162 MARINER BLVD
SPRING HILL FL
34609-1802
US

IV. Provider business mailing address

4181 GLADE RD
SPRING HILL FL
34606-6856
US

V. Phone/Fax

Practice location:
  • Phone: 352-600-8300
  • Fax: 352-251-3161
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI6056
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: