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NPI Code Detail

MEDICARE: MISS KELSIE SUE ELEDGE

MEDICARE: MISS KELSIE SUE ELEDGE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1700567492
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS KELSIE SUE ELEDGE
Provider Business Mailing Address
First Line : 314 W HUGHSON ST
Second Line :
City : RANDOLPH
State : NE
Zip : 68771-9432
Country : US
Telephone Number : 402-297-0842
Fax Number :
Provider Business Practice Location Address
First Line : 1800 W PASEWALK AVE STE A
Second Line :
City : NORFOLK
State : NE
Zip : 68701-5657
Country : US
Telephone Number : 402-500-6870
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2023
Last Update Date : 04/22/2024

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Directions to “ MISS KELSIE SUE ELEDGE ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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