Healthcare Provider Details

I. General information

NPI: 1306767306
Provider Name (Legal Business Name): EMILY KELLY
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2226 EASTLAKE AVE E OFC 255
SEATTLE WA
98102-3419
US

IV. Provider business mailing address

2226 EASTLAKE AVE E OFC 255
SEATTLE WA
98102-3419
US

V. Phone/Fax

Practice location:
  • Phone: 206-880-1196
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSYC.PY.70047016
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: