NPI | 1811388507 |
---|---|
Former Name | KELSEY LYN BOLKS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: SC .5933) |
Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: FL SA 14287) |
235Z00000X Speech-Language Pathologist, (Licence: FL SZ6851) | |
Enumeration Date | 2015-02-17 |
Last Update Date | 2016-02-24 |