Healthcare Provider Details

I. General information

NPI: 1518648237
Provider Name (Legal Business Name): JENNY ELIZABETH KELPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 07/26/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13488 SHAWNEE VALLEY RD
MARTHASVILLE MO
63357-1790
US

IV. Provider business mailing address

13488 SHAWNEE VALLEY RD
MARTHASVILLE MO
63357-1790
US

V. Phone/Fax

Practice location:
  • Phone: 314-307-7569
  • Fax:
Mailing address:
  • Phone: 314-307-7569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: