Provider Demographics
NPI:1548753890
Name:KELLOGG, ERIN LYNN (MSAT, ATC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:LYNN
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:MSAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 DONELSON PL
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-4517
Mailing Address - Country:US
Mailing Address - Phone:805-423-2267
Mailing Address - Fax:
Practice Address - Street 1:1780 DONELSON PL
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-4517
Practice Address - Country:US
Practice Address - Phone:805-423-2267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
20000388652255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program