MEDICARE: KELSEY SMITH

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	112707	TX

General Provider Information

NPI Number	:	1912420381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY SMITH

Provider Business Mailing Address
First Line	:	30362 CREPE MYRTLE CT
Second Line	:
City	:	DAPHNE
State	:	AL
Zip	:	36527-8613
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30362 CREPE MYRTLE CT
Second Line	:
City	:	DAPHNE
State	:	AL
Zip	:	36527-8613
Country	:	US
Telephone Number	:	251-422-6549
Fax Number	:

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

Provider Enumeration Date	:	07/18/2017
Last Update Date	:	07/18/2017

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Directions to “ KELSEY SMITH ” Practice Location

Language	Start Address	Practice Location

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