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NPI Code Detail

MEDICARE: KELSEY LEE ANDERSON

MEDICARE: KELSEY LEE ANDERSON
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
1103K00000XBehavior AnalystBEH-000548AZ

General Provider Information

NPI Number : 1851905715
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY LEE ANDERSON
Provider Business Mailing Address
First Line : 390 UNION BLVD STE 300
Second Line :
City : LAKEWOOD
State : CO
Zip : 80228-6514
Country : US
Telephone Number : 303-989-8172
Fax Number : 303-984-4366
Provider Business Practice Location Address
First Line : 6369 E TANQUE VERDE RD STE 100
Second Line :
City : TUCSON
State : AZ
Zip : 85715-3833
Country : US
Telephone Number : 520-276-1274
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2020
Last Update Date : 09/08/2020

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