Provider Demographics
NPI:1518418334
Name:IVERSON, KELSEY ELIZABETH
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:ELIZABETH
Last Name:IVERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:KELSEY
Other - Middle Name:ELIZABETH
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:543 RED ROCK DR
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-2210
Mailing Address - Country:US
Mailing Address - Phone:330-419-0808
Mailing Address - Fax:
Practice Address - Street 1:5311 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-3800
Practice Address - Country:US
Practice Address - Phone:330-419-0808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.12274235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist