Individual
KELSEY JACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
6078 DORSET BRIDGE RD, DOUGLASVILLE, GA 30135-6016
(361) 215-4254
Mailing address
6078 DORSET BRIDGE RD, DOUGLASVILLE, GA 30135-6016
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
012517
GA
235Z00000X
Speech-Language Pathologist
30002182
NC
Other
Enumeration date
10/04/2023
Last updated
10/04/2023
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