Healthcare Provider Details

I. General information

NPI: 1558271114
Provider Name (Legal Business Name): KELLIE WEDIG
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6930 W SCHOOL ST
THREE LAKES WI
54562-9035
US

IV. Provider business mailing address

6930 W SCHOOL ST
THREE LAKES WI
54562-9035
US

V. Phone/Fax

Practice location:
  • Phone: 715-546-3323
  • Fax:
Mailing address:
  • Phone: 715-546-3323
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1590070756
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: