Kellie Marie Lanza, MSCCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2960-154 Issued in WI

Practice address

6700 N. Port Washington Rd.
C/O St. Francis Children'S Center
Glendale, WI 53217-3919

Phone

(414) 351-8850

Fax

(414) 351-8846

NPI assigned

Aug 5, 2007

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

Other names 1

• Kellie Knutson Former name

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": "1186272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321920000000",
    "number": "1497946719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6700 N. PORT WASHINGTON RD.",
            "address_2": "C/O ST. FRANCIS CHILDREN'S CENTER",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532173919",
            "telephone_number": "414-351-8850",
            "fax_number": "414-351-8846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6700 N. PORT WASHINGTON RD.",
            "address_2": "C/O ST. FRANCIS CHILDREN'S CENTER",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532173919",
            "telephone_number": "414-351-8850",
            "fax_number": "414-351-8846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANZA",
        "first_name": "KELLIE",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "MSCCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-05",
        "last_updated": "2011-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WI",
            "license": "2960-154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLIE",
            "last_name": "KNUTSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Speech-Language Pathologist in Glendale, WI
• Providers in Glendale, 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 Nov 22, 2011; 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.