Provider Demographics
NPI:1437709094
Name:COSTANTINE, KELSEY ALYSSA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:ALYSSA
Last Name:COSTANTINE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16262 HOLLYRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-2538
Mailing Address - Country:US
Mailing Address - Phone:765-969-8647
Mailing Address - Fax:
Practice Address - Street 1:16262 HOLLYRIDGE DR
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-2538
Practice Address - Country:US
Practice Address - Phone:765-969-8647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO280017235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist