Kelsey J Lutes

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146011623 Issued in IL

Practice address

507 E Armstrong Ave
Peoria, IL 61603-3201

Phone

(309) 686-1177

Fax

(309) 686-7722

NPI assigned

Jun 29, 2012

Last updated

Jun 23, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

State licenses

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

{
    "created_epoch": "1340928000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687478400000",
    "number": "1174887509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 E ARMSTRONG AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033201",
            "telephone_number": "309-686-1177",
            "fax_number": "309-686-7722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 E ARMSTRONG AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616033201",
            "telephone_number": "309-686-1177",
            "fax_number": "309-686-7722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUTES",
        "first_name": "KELSEY",
        "middle_name": "J",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-29",
        "last_updated": "2023-06-23",
        "certification_date": "2023-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146011623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Peoria, IL
• Providers in Peoria, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2023; 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.