Kelly Witte, M.S.
Individual provider Active NPI Speech-Language Pathologist · Clinton, WI
NPI 1548603830 · NPPES record last updated Apr 17, 2013
Key facts
- NPI
- 1548603830
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 3729-154 (WI)
- Practice address
- 709 Meadow Park Dr
Clinton, WI 53525-9777 - Phone
- (608) 676-2202
- NPI assigned
- Apr 17, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Qualified Speech Language Pathologist
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Fox Rehabilitation Services Wi LLC
Practice addresses (Care Compare)
2130 Continental Dr
West Bend, WI 53095-7904
Phone (262) 338-0092
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20251112002549 | WI | Practitioner - Qualified Speech Language Pathologist | 1850882333 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3729-154 | WI | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fox Rehabilitation Services Wi LLC | Speech-Language Pathologist | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 3729-154 | WI | Yes |
Addresses
Primary practice location
709 Meadow Park Dr
Clinton, WI 53525-9777
Mailing address
800 W Main St
Suite 200 Goodhue Hall
Whitewater, WI 53190-1705
Phone (414) 840-9754
Other names
- Kelly O'Connor
Other providers in Clinton, WI
All providers in Clinton, WI · Speech-Language Pathologist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 17, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.