Healthcare Provider Details

I. General information

NPI: 1164140331
Provider Name (Legal Business Name): KELSEY MARIE OCKENFELS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSEY MARIE COLLINS

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55701 STATE HIGHWAY 6
EDINA MO
63537-4131
US

IV. Provider business mailing address

104 E SCOTT ST APT 1
KIRKSVILLE MO
63501-3572
US

V. Phone/Fax

Practice location:
  • Phone: 660-397-2228
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2022003979
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: