Provider Demographics
NPI:1609436906
Name:DADDOW, KELLY (BA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:DADDOW
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:GILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2131 CAPITOL AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5755
Mailing Address - Country:US
Mailing Address - Phone:916-284-1416
Mailing Address - Fax:
Practice Address - Street 1:2131 CAPITOL AVE STE 206
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5755
Practice Address - Country:US
Practice Address - Phone:916-284-1416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health