Healthcare Provider Details

I. General information

NPI: 1225418841
Provider Name (Legal Business Name): KAITLYNN A GUETHS SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W GREEN BAY ST
BONDUEL WI
54107-9302
US

IV. Provider business mailing address

400 W GREEN BAY ST
BONDUEL WI
54107-9302
US

V. Phone/Fax

Practice location:
  • Phone: 715-758-4850
  • Fax:
Mailing address:
  • Phone: 715-758-4850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4009
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: