Provider Demographics
NPI:1598196313
Name:PUTVIN, KELSEY LINDSAY (AUD)
Entity type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:LINDSAY
Last Name:PUTVIN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:LINDSAY
Other - Last Name:CORCORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:3520 TOWER AVE
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880
Mailing Address - Country:US
Mailing Address - Phone:715-398-2494
Mailing Address - Fax:715-398-3782
Practice Address - Street 1:400 E 3RD ST.
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805
Practice Address - Country:US
Practice Address - Phone:218-786-3419
Practice Address - Fax:218-786-3080
Is Sole Proprietor?:No
Enumeration Date:2013-12-04
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000643231H00000X
MN9991231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist