| Doctor Name: | KELSEY LEE LACK |
| NPI Number: | 1700226032 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CF-SLP |
| License Number: | 3830-154 |
| Business Practice Address: | 901 Mulberry St Lake Mills, WI - 535511335 |
| Business Phone Number: | 9206488344 |
| Business Fax Number: | |
| Mailing Address: | 860 Garden Dr, Apt. 63 SUN PRAIRIE |
| State: | WI |
| Postal Code: | 535904176 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/01/2013 |
| NPI Last Update Date: | 07/01/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 3830-154 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |