Kelly J Fisk-Wanzek, M.A., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

397218 Issued in MN

Practice address

28639 Laser Ave
Redwood Falls, MN 56283-2423

Phone

(507) 644-2017

NPI assigned

Apr 6, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083736102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28639 LASER AVE",
            "city": "REDWOOD FALLS",
            "state": "MN",
            "postal_code": "562832423",
            "telephone_number": "507-644-2017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28639 LASER AVE",
            "city": "REDWOOD FALLS",
            "state": "MN",
            "postal_code": "562832423",
            "telephone_number": "507-644-2017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISK-WANZEK",
        "first_name": "KELLY",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "M.A., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "397218",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WI",
            "license": "2827-154",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wende Joyce Davis, RN
• Krystle Dillon, PA-C
• Alicia Eliason, RN, CNP
• Mary Janet Ellison, RN
• Fischer Laser Eye Center, LLC (Family Eye Center)
• Jennifer L Flinn, PSYD, LP
• Michael William Flinn, DDS
• Christine Marie Forry Tauer, RN
• Joshua D. Friese, MD
• Deanie Reigh Fuhr, D.C.

• Speech-Language Pathologist in Redwood Falls, MN
• Providers in Redwood Falls, MN by specialty
• Speech-Language Pathologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.