Healthcare Provider Details

I. General information

NPI: 1790603751
Provider Name (Legal Business Name): MRS. KELSEY MARIE SPENCER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2146 HUMBOLDT ST
SANTA ROSA CA
95404-2456
US

IV. Provider business mailing address

2146 HUMBOLDT ST
SANTA ROSA CA
95404-2456
US

V. Phone/Fax

Practice location:
  • Phone: 415-994-5104
  • Fax:
Mailing address:
  • Phone: 415-994-5104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: