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General NPI Number Information
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NPI Number | 1205573672
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Entity Type | Individual
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Provider Name | KELSEY LAUREN GILLMOR
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Gender | Female
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Dates
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Enumeration Date | 05/17/2022
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 3529 RIVERS EDGE DR
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City | PERRYSBURG
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State | OH
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Zip | 43551-1672
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Country | US
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Telephone | 419-874-2428
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Fax |
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Provider Business Mailing Address
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Address Line | 932 TAMARACK DR
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City | WILLARD
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State | OH
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Zip | 44890-9443
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Country | US
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Telephone | 567-224-4721
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | COND.20221981-SP
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License Number State | OH
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