MEDICARE: KELSIE C SMITH 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	18017	OR

General Provider Information

NPI Number	:	1538093414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSIE C SMITH CCC-SLP

Provider Business Mailing Address
First Line	:	4329 N MISSISSIPPI AVE UNIT 5
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-3108
Country	:	US
Telephone Number	:	971-236-3627
Fax Number	:

Provider Business Practice Location Address
First Line	:	4329 N MISSISSIPPI AVE UNIT 5
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97217-3108
Country	:	US
Telephone Number	:	971-236-3627
Fax Number	:

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

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/09/2026

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Directions to “ KELSIE C SMITH CCC-SLP” Practice Location

Language	Start Address	Practice Location

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