Healthcare Provider Details

I. General information

NPI: 1053225581
Provider Name (Legal Business Name): KELSI CRIGHTON CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSI JENZER CCC-SLP

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 COUNTY ROAD B W
ROSEVILLE MN
55113-5448
US

IV. Provider business mailing address

1910 COUNTY ROAD B W
ROSEVILLE MN
55113-5448
US

V. Phone/Fax

Practice location:
  • Phone: 651-604-3724
  • Fax:
Mailing address:
  • Phone: 651-604-3724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number509826
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: