Healthcare Provider Details

I. General information

NPI: 1609458546
Provider Name (Legal Business Name): EMILY ELIZABETH KELLY-PETERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 04/21/2021
Certification Date: 04/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 5TH AVE N
SEATTLE WA
98109-4636
US

IV. Provider business mailing address

PO BOX 23350
SEATTLE WA
98102-0650
US

V. Phone/Fax

Practice location:
  • Phone: 206-470-1900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: