Healthcare Provider Details

I. General information

NPI: 1457272981
Provider Name (Legal Business Name): KELLEN WEIGAND LCPO, MPO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S SHERMAN ST
SPOKANE WA
99202-6001
US

IV. Provider business mailing address

401 S SHERMAN ST
SPOKANE WA
99202-6001
US

V. Phone/Fax

Practice location:
  • Phone: 509-624-1308
  • Fax: 509-624-5537
Mailing address:
  • Phone: 509-624-1308
  • Fax: 509-624-5537

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberORTH.OI.61558656
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberPROS.PS.61558668
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: