Kellyn Wickert, M.A.,CCC-SLP
Individual provider Active NPI Speech-Language Pathologist · Unionville, MO
NPI 1780083097 · NPPES record last updated Aug 22, 2014
Key facts
- NPI
- 1780083097
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 2014025275 (MO)
- Practice address
- 803 S 20TH St
Unionville, MO 63565-1482 - Phone
- (660) 947-3361
- Fax
- (660) 947-2912
- NPI assigned
- Aug 22, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2014025275 | MO | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Putnam County R-I Schools | Speech-Language Pathologist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2014025275 | MO | Yes |
Addresses
Primary practice location
803 S 20TH St
Unionville, MO 63565-1482
Mailing address
803 S 20TH St
Unionville, MO 63565-1482
Phone (660) 947-3361
Other providers in Unionville, MO
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- Lee S Vorkink
- Wa Heffron III Chiropractic Clinic Inc
- Deborah K Wardlow
- Maurice J Warner
- Aurelia Young
- Christopher Davis Yunick
All providers in Unionville, MO · Speech-Language Pathologist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.