Healthcare Provider Details

I. General information

NPI: 1801146899
Provider Name (Legal Business Name): SHANNON KELSCH AAHCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9307 191ST ST E
PUYALLUP WA
98375-6163
US

IV. Provider business mailing address

9307 191ST ST E
PUYALLUP WA
98375-6163
US

V. Phone/Fax

Practice location:
  • Phone: 253-720-7566
  • Fax:
Mailing address:
  • Phone: 253-720-7566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: