Provider Demographics
NPI:1174981963
Name:ORLANDO, KELSEY ROSE
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:ROSE
Last Name:ORLANDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:ROSE
Other - Last Name:VOSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:65899 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48095-2014
Mailing Address - Country:US
Mailing Address - Phone:586-942-2620
Mailing Address - Fax:586-317-6677
Practice Address - Street 1:65899 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48095-2014
Practice Address - Country:US
Practice Address - Phone:586-942-2620
Practice Address - Fax:586-317-6677
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-08
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101004701235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1174981963OtherBLUE CROSS
MI1174981963OtherBLUE CARE NETWORK
MI1174981963Medicaid