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General NPI Number Information
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NPI Number | 1902626955
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Entity Type | Individual
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Provider Name | KELSI RENEE MAINARD SLPA
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Gender | Female
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 101 MEGHAN DR
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City | HARRISONVILLE
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State | MO
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Zip | 64701-3926
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Country | US
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Telephone | 816-590-3983
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Fax |
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Provider Business Mailing Address
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Address Line | 31625 S THREE TEES RD
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City | CREIGHTON
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State | MO
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Zip | 64739-8501
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Country | US
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Telephone | 816-590-3983
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 2024033137
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License Number State | MO
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