Healthcare Provider Details

I. General information

NPI: 1376566067
Provider Name (Legal Business Name): KATRINA RENEE GELHAUSEN M.S. CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 HEATHERVIEW DR
EAST PEORIA IL
61611-4889
US

IV. Provider business mailing address

10132 MENCHALVILLE RD
REEDSVILLE WI
54230-8008
US

V. Phone/Fax

Practice location:
  • Phone: 309-360-0707
  • Fax:
Mailing address:
  • Phone: 920-901-2684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1757-154
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number696980
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: