MEDICARE: KELSEY GORDON 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	8123	SC

General Provider Information

NPI Number	:	1376327072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY GORDON SLP

Provider Business Mailing Address
First Line	:	714 S LAKE DR
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-3462
Country	:	US
Telephone Number	:	803-356-4782
Fax Number	:	803-996-4782

Provider Business Practice Location Address
First Line	:	714 S LAKE DR
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-3462
Country	:	US
Telephone Number	:	803-356-4782
Fax Number	:	803-996-4782

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

Provider Enumeration Date	:	08/23/2023
Last Update Date	:	08/23/2023

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Directions to “ KELSEY GORDON SLP” Practice Location

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