Provider Demographics
NPI:1487907788
Name:SANTOEMMA, KELCI LAUREN (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KELCI
Middle Name:LAUREN
Last Name:SANTOEMMA
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 1:2455 HEATHER RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17408-4384
Mailing Address - Country:US
Mailing Address - Phone:570-574-8104
Mailing Address - Fax:
Practice Address - Street 1:100 KIMBALL AVE APT H96
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-6709
Practice Address - Country:US
Practice Address - Phone:570-574-8104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006725235Z00000X
PASL012931235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist