Provider Demographics
NPI:1730370982
Name:GILLIS, KASI M (MSE, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KASI
Middle Name:M
Last Name:GILLIS
Suffix:
Gender:F
Credentials:MSE, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 W WARREN ST
Mailing Address - Street 2:P.O. BOX 220
Mailing Address - City:ROBERTS
Mailing Address - State:WI
Mailing Address - Zip Code:54023-9617
Mailing Address - Country:US
Mailing Address - Phone:715-749-3890
Mailing Address - Fax:715-749-4081
Practice Address - Street 1:204 W WARREN ST
Practice Address - Street 2:
Practice Address - City:ROBERTS
Practice Address - State:WI
Practice Address - Zip Code:54023-9617
Practice Address - Country:US
Practice Address - Phone:715-749-3890
Practice Address - Fax:715-749-4081
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2966-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist