Healthcare Provider Details

I. General information

NPI: 1619539111
Provider Name (Legal Business Name): KELLI BROWNFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2019
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 HILTON CORPORATE DR
COLUMBUS OH
43232-4151
US

IV. Provider business mailing address

10100 ELIDA RD
DELPHOS OH
45833-9056
US

V. Phone/Fax

Practice location:
  • Phone: 614-729-2024
  • Fax: 614-729-2030
Mailing address:
  • Phone: 614-729-2024
  • Fax: 614-729-2030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: