Healthcare Provider Details

I. General information

NPI: 1598068025
Provider Name (Legal Business Name): KELLI L JANOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

YMCA ASSOCIATION OFFICE 100 WEST 10TH STREET, SUITE 1100
WILMINGTON DE
19801
US

IV. Provider business mailing address

YMCA ASSOCIATION OFFICE 100 WEST 10TH STREET, SUITE 1100
WILMINGTON DE
19801
US

V. Phone/Fax

Practice location:
  • Phone: 302-221-9622
  • Fax:
Mailing address:
  • Phone: 302-221-9622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN-0000211
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: