Individual
KELLY WONITOWY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
1406 SE 85TH AVE, PORTLAND, OR 97216-1324
(971) 227-0523
Mailing address
1406 SE 85TH AVE, PORTLAND, OR 97216-1324
(971) 227-0523
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
12405
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12008751
ASHA
—
Enumeration date
09/29/2014
Last updated
09/29/2014
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