Provider Demographics
NPI:1598068025
Name:JANOWSKI, KELLI L
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:L
Last Name:JANOWSKI
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:YMCA ASSOCIATION OFFICE
Mailing Address - Street 2:100 WEST 10TH STREET, SUITE 1100
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801
Mailing Address - Country:US
Mailing Address - Phone:302-221-9622
Mailing Address - Fax:
Practice Address - Street 1:YMCA ASSOCIATION OFFICE
Practice Address - Street 2:100 WEST 10TH STREET, SUITE 1100
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801
Practice Address - Country:US
Practice Address - Phone:302-221-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-06
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE174H00000X
DEDN-0000211133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No174H00000XOther Service ProvidersHealth Educator