Provider Demographics
NPI:1376566067
Name:GELHAUSEN, KATRINA RENEE (MS CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:RENEE
Last Name:GELHAUSEN
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10132 MENCHALVILLE RD
Mailing Address - Street 2:
Mailing Address - City:REEDSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54230-8008
Mailing Address - Country:US
Mailing Address - Phone:920-901-2684
Mailing Address - Fax:
Practice Address - Street 1:112 HEATHERVIEW DR
Practice Address - Street 2:
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-4889
Practice Address - Country:US
Practice Address - Phone:309-360-0707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1757-154235Z00000X
WI696980235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI696980OtherPROFESSIONAL EDUCATOR LICENSE
WI1757-154OtherSTATE LICENSE