Provider Demographics
NPI:1538894092
Name:MUMME, KELSEY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:MUMME
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:GROFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP-INTERN
Mailing Address - Street 1:109 SUNNYLAND DR
Mailing Address - Street 2:
Mailing Address - City:CASTROVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78009-5001
Mailing Address - Country:US
Mailing Address - Phone:210-414-5056
Mailing Address - Fax:
Practice Address - Street 1:1312 GENEVA ST STE B
Practice Address - Street 2:
Practice Address - City:CASTROVILLE
Practice Address - State:TX
Practice Address - Zip Code:78009-2941
Practice Address - Country:US
Practice Address - Phone:830-214-7640
Practice Address - Fax:830-632-5884
Is Sole Proprietor?:No
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114008235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist