Provider Demographics
NPI:1033534219
Name:KELLOGG, ANNE EDITH (LMFT)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:EDITH
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:ANNE
Other - Middle Name:EDITH
Other - Last Name:KELLOGG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:175 N OREGON ST
Mailing Address - Street 2:#1004
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530-9797
Mailing Address - Country:US
Mailing Address - Phone:855-343-6012
Mailing Address - Fax:
Practice Address - Street 1:135 E E ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97530-9246
Practice Address - Country:US
Practice Address - Phone:855-343-6012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0600106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist