Healthcare Provider Details

I. General information

NPI: 1881415073
Provider Name (Legal Business Name): KELSIE ROSE CIOCCA CNTP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSIE ROSE CHRISTIAN CNTP

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 CRESTVIEW RD
STERLING IL
61081-4313
US

IV. Provider business mailing address

1205 CRESTVIEW RD
STERLING IL
61081-4313
US

V. Phone/Fax

Practice location:
  • Phone: 815-213-0240
  • Fax:
Mailing address:
  • Phone: 815-213-0240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: