Provider Demographics
NPI:1801628615
Name:RITSICK, KELLY
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:RITSICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 1/2 DURKEE ST
Mailing Address - Street 2:
Mailing Address - City:FORTY FORT
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4206
Mailing Address - Country:US
Mailing Address - Phone:570-301-8400
Mailing Address - Fax:
Practice Address - Street 1:34 1/2 DURKEE ST
Practice Address - Street 2:
Practice Address - City:FORTY FORT
Practice Address - State:PA
Practice Address - Zip Code:18704-4206
Practice Address - Country:US
Practice Address - Phone:570-301-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist