Provider Demographics
NPI:1326734070
Name:WRIGHT, KELLIE JO
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:JO
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E WAY TO TIPPERARY ST
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-9646
Mailing Address - Country:US
Mailing Address - Phone:909-273-9600
Mailing Address - Fax:
Practice Address - Street 1:417 E PIONEER STE B
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3267
Practice Address - Country:US
Practice Address - Phone:253-285-8673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor