Healthcare Provider Details

I. General information

NPI: 1538968045
Provider Name (Legal Business Name): KELSEY HOLLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 RAILROAD ST
ST JOHNSBURY VT
05819-1739
US

IV. Provider business mailing address

PO BOX 699
LYNDONVILLE VT
05851-0699
US

V. Phone/Fax

Practice location:
  • Phone: 802-424-1042
  • Fax:
Mailing address:
  • Phone: 802-424-1042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-79663
License Number StateNH

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: