Provider Demographics
NPI:1659048940
Name:SCHUTZ, KELCI (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KELCI
Middle Name:
Last Name:SCHUTZ
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 1:1771 CENTENNIAL DR STE 220
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-8404
Mailing Address - Country:US
Mailing Address - Phone:307-742-3571
Mailing Address - Fax:
Practice Address - Street 1:1771 CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-8403
Practice Address - Country:US
Practice Address - Phone:307-742-3571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYCFY-1244235Z00000X
WYSP-1244235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist