Provider Demographics
NPI:1003779232
Name:HIETPAS, KELSEY (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:HIETPAS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 W GREENFIELD DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE CHUTE
Mailing Address - State:WI
Mailing Address - Zip Code:54140-1141
Mailing Address - Country:US
Mailing Address - Phone:920-850-9974
Mailing Address - Fax:
Practice Address - Street 1:1402 FREEDOM RD
Practice Address - Street 2:
Practice Address - City:LITTLE CHUTE
Practice Address - State:WI
Practice Address - Zip Code:54140-1313
Practice Address - Country:US
Practice Address - Phone:920-788-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-12-04
Last Update Date:2025-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14130053235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist