Provider Demographics
NPI:1932511508
Name:KINNARNEY, KELSEY ANN (SLP)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:ANN
Last Name:KINNARNEY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:KELSEY
Other - Middle Name:ANN
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2913 W BRODERIE LN
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:IN
Mailing Address - Zip Code:46157-6131
Mailing Address - Country:US
Mailing Address - Phone:812-929-1060
Mailing Address - Fax:
Practice Address - Street 1:2913 W BRODERIE LN
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:IN
Practice Address - Zip Code:46157-6131
Practice Address - Country:US
Practice Address - Phone:812-929-1060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 14874235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist