Provider Demographics
NPI:1235265935
Name:KELL, ADELINE MICHELLE (ND)
Entity Type:Individual
Prefix:
First Name:ADELINE
Middle Name:MICHELLE
Last Name:KELL
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39809 NE 94TH AVE
Mailing Address - Street 2:
Mailing Address - City:LA CENTER
Mailing Address - State:WA
Mailing Address - Zip Code:98629-4813
Mailing Address - Country:US
Mailing Address - Phone:503-753-6352
Mailing Address - Fax:360-841-8428
Practice Address - Street 1:339 BOZARTH AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:WA
Practice Address - Zip Code:98674-8424
Practice Address - Country:US
Practice Address - Phone:360-841-8336
Practice Address - Fax:360-841-8428
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1299175F00000X
WA00001347175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR277820Medicaid