Provider Demographics
NPI:1922350776
Name:WHELAN, KELLY JENELLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:JENELLE
Last Name:WHELAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4606 N COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-5456
Mailing Address - Country:US
Mailing Address - Phone:307-414-8394
Mailing Address - Fax:307-316-8125
Practice Address - Street 1:2546 E 2ND ST
Practice Address - Street 2:BUILDING #500
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2062
Practice Address - Country:US
Practice Address - Phone:307-577-5204
Practice Address - Fax:307-577-5212
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-03
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP-452235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty