Provider Demographics
NPI:1881788628
Name:LHOTKA, KELLY ANN (SLP)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:LHOTKA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 S CHANDLER AVE
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55355-3406
Mailing Address - Country:US
Mailing Address - Phone:320-214-7082
Mailing Address - Fax:320-235-8059
Practice Address - Street 1:312 4TH ST SW
Practice Address - Street 2:SUITE 11
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3332
Practice Address - Country:US
Practice Address - Phone:320-214-7082
Practice Address - Fax:320-235-8059
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8113235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist