Provider Demographics
NPI:1629385414
Name:KELLOGG, KATE MARIE (LAC)
Entity Type:Individual
Prefix:MRS
First Name:KATE
Middle Name:MARIE
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 W 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-3322
Mailing Address - Country:US
Mailing Address - Phone:303-257-9102
Mailing Address - Fax:
Practice Address - Street 1:2416 W 32ND AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80211-3322
Practice Address - Country:US
Practice Address - Phone:303-257-9102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-01
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1264171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist