Provider Demographics
NPI:1710574850
Name:ILETO, KELLIE CATHERINE
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:CATHERINE
Last Name:ILETO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 8TH AVENUE EAST N
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3244
Mailing Address - Country:US
Mailing Address - Phone:301-351-4420
Mailing Address - Fax:
Practice Address - Street 1:392 8TH AVENUE EAST N
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3244
Practice Address - Country:US
Practice Address - Phone:301-351-4420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08600235Z00000X
CA39752235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist