Provider Demographics
NPI:1659970101
Name:BUCCELLA, KELSI (SLP-CCC)
Entity type:Individual
Prefix:
First Name:KELSI
Middle Name:
Last Name:BUCCELLA
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 DIXON AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:PA
Mailing Address - Zip Code:19007-2519
Mailing Address - Country:US
Mailing Address - Phone:646-714-8556
Mailing Address - Fax:
Practice Address - Street 1:3515 DIXON AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:PA
Practice Address - Zip Code:19007-2519
Practice Address - Country:US
Practice Address - Phone:646-714-8556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-25
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP0003756235Z00000X
PASL016221235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist