MEDICARE: KELSIE LANE HAMMER M.S., 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	115254	TX

General Provider Information

NPI Number	:	1821561275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSIE LANE HAMMER M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	1520 CAMELIA DR
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-4207
Country	:	US
Telephone Number	:	870-723-8699
Fax Number	:

Provider Business Practice Location Address
First Line	:	3605 YUCCA DR STE 102
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-2753
Country	:	US
Telephone Number	:	870-723-8699
Fax Number	:

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

Provider Enumeration Date	:	01/08/2019
Last Update Date	:	11/11/2021

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Directions to “ KELSIE LANE HAMMER M.S., CCC-SLP” Practice Location

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