Provider Demographics
NPI:1538154091
Name:WAUTHIER, KELLY LYNN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:LYNN
Last Name:WAUTHIER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:LYNN
Other - Last Name:GACHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:424 FREDERICK AVE
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1523
Mailing Address - Country:US
Mailing Address - Phone:412-741-4087
Mailing Address - Fax:412-741-6808
Practice Address - Street 1:424 FREDERICK AVE
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1523
Practice Address - Country:US
Practice Address - Phone:412-741-4087
Practice Address - Fax:412-741-6808
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL003861L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5548728OtherAETNA NON-HMO
PA89570OtherTHREE RIVERS HEALTH PLAN
PA709370OtherBLUE CROSS BLUE SHIELD
PA1523227OtherGATEWAY HEALTH PLANS
PA0017299320001Medicaid
PA2109056OtherAETNA HMO