Active NPI
Kelly Wonitowy, MS, CCC-SLP
- Speech-Language Pathologist
- Portland, OR
National Provider Identifier
1013310531
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 12405
- Practice address
- 1406 SE 85TH Ave
Portland, OR 97216-1324 - Phone
- (971) 227-0523
- NPI assigned
- Sep 29, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 12405 | OR | Primary |
Addresses
Primary practice location
1406 SE 85TH Ave
Portland, OR 97216-1324
Mailing address
1406 SE 85TH Ave
Portland, OR 97216-1324
Phone (971) 227-0523
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12008751 | Other | ASHA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12405 | OR | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1411948800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1411948800000",
"number": "1013310531",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1406 SE 85TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972161324",
"telephone_number": "971-227-0523"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1406 SE 85TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972161324",
"telephone_number": "971-227-0523"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONITOWY",
"first_name": "KELLY",
"credential": "MS, CCC-SLP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-09-29",
"last_updated": "2014-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "OR",
"license": "12405",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ASHA",
"identifier": "12008751",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.