Provider Demographics
NPI:1003970591
Name:PREDIERI, KELLY ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANN
Last Name:PREDIERI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2365 LAKEVIEW DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-4600
Mailing Address - Country:US
Mailing Address - Phone:937-320-1218
Mailing Address - Fax:937-320-0824
Practice Address - Street 1:2365 LAKEVIEW DR
Practice Address - Street 2:SUITE B
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-4600
Practice Address - Country:US
Practice Address - Phone:937-320-1218
Practice Address - Fax:937-320-0824
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5479103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRCP25341Medicare ID - Type Unspecified