Provider Demographics
NPI:1467002113
Name:WILTROUT, KELSEE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELSEE
Middle Name:
Last Name:WILTROUT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KELSEE
Other - Middle Name:
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:95 WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-3064
Mailing Address - Country:US
Mailing Address - Phone:724-809-0635
Mailing Address - Fax:
Practice Address - Street 1:1379 VAN VOORHIS RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3415
Practice Address - Country:US
Practice Address - Phone:304-599-9480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAP-SLP-0893235Z00000X
PASL015693235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist