MEDICARE: KELSEY PAULK MS CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	19483	FL

General Provider Information

NPI Number	:	1114327368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY PAULK MS CCC-SLP

Provider Business Mailing Address
First Line	:	700 W 23RD ST STE B20
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-3936
Country	:	US
Telephone Number	:	850-348-1057
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 W 23RD ST STE B20
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-3936
Country	:	US
Telephone Number	:	850-348-1057
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2014
Last Update Date	:	06/08/2026

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Directions to “ KELSEY PAULK MS CCC-SLP” Practice Location

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