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NPI Code Detail

MEDICARE: KELLIE FUSCO

MEDICARE: KELLIE FUSCO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health CounselorOR

General Provider Information

NPI Number : 1538843859
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLIE FUSCO
Provider Business Mailing Address
First Line : PO BOX 1121
Second Line :
City : ROSEBURG
State : OR
Zip : 97470-0254
Country : US
Telephone Number : 541-672-2691
Fax Number :
Provider Business Practice Location Address
First Line : 548 SE JACKSON ST
Second Line :
City : ROSEBURG
State : OR
Zip : 97470-4983
Country : US
Telephone Number : 541-440-3554
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2023
Last Update Date : 05/19/2026

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Directions to “ KELLIE FUSCO ” Practice Location

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