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Individual
MRS. KELLY JO PAULSEN
Active
Individual
MRS. KELLY JO PAULSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS CCC-SLP
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146004766
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
146004766
IDFPR
IL
Enumeration date
10/06/2017
Last updated
06/16/2018
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