Healthcare Provider Details

I. General information

NPI: 1235265935
Provider Name (Legal Business Name): ADELINE MICHELLE KELL ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 BOZARTH AVE
WOODLAND WA
98674-8424
US

IV. Provider business mailing address

39809 NE 94TH AVE
LA CENTER WA
98629-4813
US

V. Phone/Fax

Practice location:
  • Phone: 360-841-8336
  • Fax: 360-841-8428
Mailing address:
  • Phone: 503-753-6352
  • Fax: 360-841-8428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1299
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number00001347
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: