Provider Demographics
NPI:1205187614
Name:HERBER, KELLIE LOUISE (MA)
Entity Type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:LOUISE
Last Name:HERBER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 FLAXMILL RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-1370
Mailing Address - Country:US
Mailing Address - Phone:260-224-2819
Mailing Address - Fax:
Practice Address - Street 1:1316 FLAXMILL RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-1370
Practice Address - Country:US
Practice Address - Phone:260-224-2819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS