Provider Demographics
NPI:1225900822
Name:GREGSON, KELCI (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KELCI
Middle Name:
Last Name:GREGSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KELCI
Other - Middle Name:
Other - Last Name:CARRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-1570
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:526 LEGACY DR
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-1784
Practice Address - Country:US
Practice Address - Phone:573-880-1556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-22
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021018669235Z00000X
IL146.018603235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist