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General NPI Number Information
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NPI Number | 1689148561
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Entity Type | Individual
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Provider Name | KELSEY CORDELL
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Gender | Female
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Dates
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Enumeration Date | 01/14/2019
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Last Update Date | 06/15/2022
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Provider Practice Location Address
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Address Line | 7318 W POST RD STE 208
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City | LAS VEGAS
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State | NV
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Zip | 89113-6646
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Country | US
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Telephone | 800-249-1266
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Fax |
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Provider Business Mailing Address
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Address Line | 15927 SE LAKE HOLM RD
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City | AUBURN
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State | WA
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Zip | 98092-5928
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Country | US
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Telephone | 253-228-5529
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | CB60926979
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License Number State | WA
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