Provider Demographics
NPI:1902034739
Name:VANT, KELLY A (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:VANT
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 COMMERCE DR
Mailing Address - Street 2:SUITE 114
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-3700
Mailing Address - Country:US
Mailing Address - Phone:262-886-3431
Mailing Address - Fax:262-886-3954
Practice Address - Street 1:1100 COMMERCE DR
Practice Address - Street 2:SUITE 114
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-3700
Practice Address - Country:US
Practice Address - Phone:262-886-3431
Practice Address - Fax:262-886-3954
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3223-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist