Kelly Morgan Petrillo

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Practice address

10330 Prairie Ridge Blvd
Pleasant Prairie, WI 53158-1947

Phone

(262) 612-2800

NPI assigned

Mar 18, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Oasis Therapy Services LLC

  • Multi-Specialty Clinic/Center
  • Oshkosh, WI
  • NPI 1386381598

  Speech-Language Pathologist

  NPD

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

{
    "created_epoch": "1710720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710720000000",
    "number": "1326807983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 AMHERST DR",
            "city": "LAKE VILLA",
            "state": "IL",
            "postal_code": "600465238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10330 PRAIRIE RIDGE BLVD",
            "city": "PLEASANT PRAIRIE",
            "state": "WI",
            "postal_code": "531581947",
            "telephone_number": "262-612-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRILLO",
        "first_name": "KELLY",
        "middle_name": "MORGAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-03-18",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle C Paulowske, OT
• Pearle Vision
• Zakkary A Perez,, PT
• Jacob Michael Perotto, DPT
• Lisa Peterson, PTA
• Lori Pettit, PTA
• Ajish Isac Philip, PHARM.D.
• Amy H Piko, O.D.
• Dwayne Pinon
• Jill Plaisted

• Speech-Language Pathologist in Pleasant Prairie, WI
• Providers in Pleasant Prairie, WI by specialty
• Speech-Language Pathologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2024; 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.