Provider Demographics
NPI:1235534199
Name:UITENHAM, KELLI (CLINSCID, CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:KELLI
Middle Name:
Last Name:UITENHAM
Suffix:
Gender:F
Credentials:CLINSCID, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TELEMEDICINE SERVICES
Mailing Address - Street 2:4044 QUEENSBRIDGE RD
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4895
Mailing Address - Country:US
Mailing Address - Phone:828-548-3155
Mailing Address - Fax:704-285-2420
Practice Address - Street 1:4044 QUEENSBRIDGE RD STE A
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4895
Practice Address - Country:US
Practice Address - Phone:828-548-3155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTPSA39235Z00000X
MA77850235Z00000X
IN22006140A235Z00000X
VA2202008045235Z00000X
CA26731235Z00000X
NC11412235Z00000X
GASLP009134235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty