Provider Demographics
NPI:1619526993
Name:ALLEN, KELLY DIANE
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:DIANE
Last Name:ALLEN
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 1:1950 KEENE RD BLDG L
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-7752
Mailing Address - Country:US
Mailing Address - Phone:509-420-3442
Mailing Address - Fax:858-521-8173
Practice Address - Street 1:1950 KEENE RD BLDG L
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-7752
Practice Address - Country:US
Practice Address - Phone:509-420-3442
Practice Address - Fax:858-521-8173
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst