MEDICARE: KAZHRA ANGELIQUE MAYAN KELCHO

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

General Provider Information

NPI Number	:	1568394476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAZHRA ANGELIQUE MAYAN KELCHO

Provider Business Mailing Address
First Line	:	308 N 76TH PL
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85207-7514
Country	:	US
Telephone Number	:	623-241-3886
Fax Number	:

Provider Business Practice Location Address
First Line	:	308 N 76TH PL
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85207-7514
Country	:	US
Telephone Number	:	623-241-3886
Fax Number	:

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

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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Directions to “ KAZHRA ANGELIQUE MAYAN KELCHO ” Practice Location

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