Individual
KELLI WILTBANK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP-CCC
Contact information
Practice address
24937 S SOSSAMAN RD, QUEEN CREEK, AZ 85142-6571
(480) 826-0847
Mailing address
20217 E CHANDLER HEIGHTS RD, QUEEN CREEK, AZ 85142-9521
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
14763
AZ
235Z00000X
Speech-Language Pathologist
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1316163884
—
AZ
Enumeration date
01/06/2023
Last updated
03/31/2025
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