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NPI Code Detail

MEDICARE: KELSEY SVENSON MS, CCC-SLP

MEDICARE: KELSEY SVENSON 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
1222Q00000XDevelopmental Therapist
2235Z00000XSpeech-Language Pathologist30280CA

General Provider Information

NPI Number : 1679959662
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY SVENSON MS, CCC-SLP
Provider Business Mailing Address
First Line : 84 SOUTH ST
Second Line : 2
City : MEDFORD
State : MA
Zip : 02155-7120
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7525 METROPOLITAN DR STE 308
Second Line :
City : SAN DIEGO
State : CA
Zip : 92108-4412
Country : US
Telephone Number : 619-692-0622
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2015
Last Update Date : 08/04/2020

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