Provider Demographics
NPI:1548758246
Name:SMITH BRAMLAGE, KELLEY NICOLE (MA, ECSE)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:NICOLE
Last Name:SMITH BRAMLAGE
Suffix:
Gender:F
Credentials:MA, ECSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-4042
Mailing Address - Country:US
Mailing Address - Phone:303-601-3034
Mailing Address - Fax:
Practice Address - Street 1:820 HARRISON ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-4042
Practice Address - Country:US
Practice Address - Phone:303-601-3034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty