MEDICARE: KATHLEEN CRYSTAL KELSAY

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	SZ5164	FL
2	235Z00000X	Speech-Language Pathologist	SA11039	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619294006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN CRYSTAL KELSAY

Provider Business Mailing Address
First Line	:	2447 NE 17TH CT
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-7325
Country	:	US
Telephone Number	:	772-708-9383
Fax Number	:

Provider Business Practice Location Address
First Line	:	2447 NE 17TH CT
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-7325
Country	:	US
Telephone Number	:	772-708-9383
Fax Number	:	772-708-9383

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

Provider Enumeration Date	:	04/26/2010
Last Update Date	:	09/23/2013

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Directions to “ KATHLEEN CRYSTAL KELSAY ” Practice Location

Language	Start Address	Practice Location

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