Individual
KELSEY ELIZABETH SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2101 WOODDALE DR STE A, WOODBURY, MN 55125-2933
(651) 738-9888
Mailing address
2101 WOODDALE DR STE A, WOODBURY, MN 55125-2933
(651) 738-9888
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
528486
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
S530-5059-8690-02
DRIVER'S LICENSE
WI
Enumeration date
10/03/2022
Last updated
10/03/2022
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