Provider Demographics
NPI:1639869316
Name:BRUTOUT, KELSEY JANE
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:JANE
Last Name:BRUTOUT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:JANE
Other - Last Name:BRUTOUT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS CCC-SLP
Mailing Address - Street 1:503 CYPRESS CT
Mailing Address - Street 2:
Mailing Address - City:TRAFFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15085-1414
Mailing Address - Country:US
Mailing Address - Phone:724-689-3298
Mailing Address - Fax:
Practice Address - Street 1:1153 CLARIDGE ELLIOTT RD
Practice Address - Street 2:
Practice Address - City:JEANNETTE
Practice Address - State:PA
Practice Address - Zip Code:15644-4537
Practice Address - Country:US
Practice Address - Phone:724-787-0009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA015466235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist