Provider Demographics
NPI:1356779144
Name:CARTEE, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:CARTEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:GRABOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6040 W 89TH LN
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-5195
Mailing Address - Country:US
Mailing Address - Phone:815-919-1352
Mailing Address - Fax:
Practice Address - Street 1:3301 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2614
Practice Address - Country:US
Practice Address - Phone:219-462-0508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46002521A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN46002521AOtherINDIANA PROFESSIONAL LICENSING AGENCY