Provider Demographics
NPI:1871976167
Name:MCMULLEN, KELSEY JO
Entity type:Individual
Prefix:MISS
First Name:KELSEY
Middle Name:JO
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9555 N COUNTY ROAD 800 E
Mailing Address - Street 2:
Mailing Address - City:BROWNSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:46112-9255
Mailing Address - Country:US
Mailing Address - Phone:317-442-0326
Mailing Address - Fax:
Practice Address - Street 1:9555 N COUNTY ROAD 800 E
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-9255
Practice Address - Country:US
Practice Address - Phone:317-442-0326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-04
Last Update Date:2015-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46002722A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist