Individual
MRS. KELSEY JO HEAVENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CCC-SLP
Contact information
Practice address
301 E MAIN ST, ROMNEY, WV 26757-1828
(304) 822-4809
Mailing address
301 E MAIN ST, ROMNEY, WV 26757-1828
(304) 822-4809
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
14290155
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
556000837
—
WV
Enumeration date
06/06/2018
Last updated
06/06/2018
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