Individual
MRS. KELLY LYNN WAUTHIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
424 FREDERICK AVE, SEWICKLEY, PA 15143-1523
(412) 741-4087
(412) 741-6808
Mailing address
424 FREDERICK AVE, SEWICKLEY, PA 15143-1523
(412) 741-4087
(412) 741-6808
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SL003861L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017299320001
—
PA
01
—
1523227
GATEWAY HEALTH PLANS
PA
01
—
2109056
AETNA HMO
PA
01
—
5548728
AETNA NON-HMO
PA
01
—
709370
BLUE CROSS BLUE SHIELD
PA
01
—
89570
THREE RIVERS HEALTH PLAN
PA
Enumeration date
09/12/2005
Last updated
07/09/2007
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