Healthcare Provider Details

I. General information

NPI: 1447199542
Provider Name (Legal Business Name): KELLY GRIFFITH CGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W 8TH AVE STE 454E
SPOKANE WA
99204-2318
US

IV. Provider business mailing address

PO BOX 31001-4114
PASADENA CA
91110-0001
US

V. Phone/Fax

Practice location:
  • Phone: 509-474-3810
  • Fax:
Mailing address:
  • Phone: 866-747-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License NumberGT70107940
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: