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General NPI Number Information
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NPI Number | 1053036285
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Entity Type | Individual
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Provider Name | KELSHA LOPEZ-RAM
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Gender | Female
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Dates
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Enumeration Date | 10/10/2022
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 7808 PACIFIC AVE STE 9
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City | TACOMA
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State | WA
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Zip | 98408-7039
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Country | US
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Telephone | 253-653-8278
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Fax |
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Provider Business Mailing Address
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Address Line | 1318 83RD STREET CT E
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City | TACOMA
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State | WA
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Zip | 98404-5907
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Country | US
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Telephone | 253-653-8278
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | AB61562663
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License Number State | WA
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