Healthcare Provider Details

I. General information

NPI: 1922853902
Provider Name (Legal Business Name): KELSEY FLAKE CADC R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2024
Last Update Date: 04/22/2024
Certification Date: 04/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 NW GREENWOOD AVE
BEND OR
97703-2078
US

IV. Provider business mailing address

2934 NE WELLS ACRES RD
BEND OR
97701-7620
US

V. Phone/Fax

Practice location:
  • Phone: 541-383-4293
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: