Provider Demographics
NPI:1316274384
Name:CAMILOTTO, KATHRYN R (MS/CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:R
Last Name:CAMILOTTO
Suffix:
Gender:F
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:PAULS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2915 N MEADE ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-1509
Mailing Address - Country:US
Mailing Address - Phone:920-993-6837
Mailing Address - Fax:
Practice Address - Street 1:2915 N MEADE ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-1509
Practice Address - Country:US
Practice Address - Phone:920-993-6837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-11
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2660-154235Z00000X
WI2660235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist