MEDICARE: KELSEA C OWENS 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	107244	TX

General Provider Information

NPI Number	:	1154040129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEA C OWENS MS,CCC-SLP

Provider Business Mailing Address
First Line	:	PO BOX 399
Second Line	:
City	:	FALLS CITY
State	:	TX
Zip	:	78113-0399
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 N NELSON ST
Second Line	:
City	:	FALLS CITY
State	:	TX
Zip	:	78113-6113
Country	:	US
Telephone Number	:	830-254-3551
Fax Number	:

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

Provider Enumeration Date	:	08/24/2022
Last Update Date	:	08/24/2022

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