Provider Demographics
NPI:1437653656
Name:BALIDOY, KELSEY K
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:K
Last Name:BALIDOY
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 1:2029 NU PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2236
Mailing Address - Country:US
Mailing Address - Phone:808-304-9245
Mailing Address - Fax:
Practice Address - Street 1:2029 NU PL
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2236
Practice Address - Country:US
Practice Address - Phone:808-304-9245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician