MEDICARE: KELSI LUND 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	SP-6412	ID

General Provider Information

NPI Number	:	1477362903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSI LUND MS, CCC-SLP

Provider Business Mailing Address
First Line	:	2071 DAKOTA LN
Second Line	:
City	:	AMMON
State	:	ID
Zip	:	83406-5068
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	630 S WOODRUFF AVE STE D3
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83401-6472
Country	:	US
Telephone Number	:	701-340-0356
Fax Number	:

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

Provider Enumeration Date	:	12/30/2024
Last Update Date	:	03/11/2026

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Directions to “ KELSI LUND MS, CCC-SLP” Practice Location

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