Provider Demographics
NPI:1598359325
Name:KELTCH, KIM L (MSW)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:L
Last Name:KELTCH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 ROAD 52
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-3045
Mailing Address - Country:US
Mailing Address - Phone:503-720-2864
Mailing Address - Fax:
Practice Address - Street 1:220 W KENNEWICK AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-3828
Practice Address - Country:US
Practice Address - Phone:503-720-2864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker