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Individual
MRS. KELSEY FORTUNE DALENE
Active
Individual
MRS. KELSEY FORTUNE DALENE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.ED. CCC-SLP
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP008991
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003168336A
—
GA
Enumeration date
08/12/2015
Last updated
01/25/2018
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