Healthcare Provider Details

I. General information

NPI: 1073329934
Provider Name (Legal Business Name): KELLIE MICHELLE RAMDEEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 09/13/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 CLARENDON RD
INDIANAPOLIS IN
46208-2429
US

IV. Provider business mailing address

5353 CLARENDON RD
INDIANAPOLIS IN
46208-2429
US

V. Phone/Fax

Practice location:
  • Phone: 317-210-1137
  • Fax:
Mailing address:
  • Phone: 317-210-1137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: