Provider Demographics
NPI:1710667746
Name:RAMIREZ, KELLY LEIGH (DSP)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LEIGH
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:DSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4031 W DAYTON ST
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-8377
Mailing Address - Country:US
Mailing Address - Phone:815-344-1230
Mailing Address - Fax:
Practice Address - Street 1:PIONEER CENTER FOR HUMAN SERVICES
Practice Address - Street 2:4031 W. DAYTON ST
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-5541
Practice Address - Country:US
Practice Address - Phone:815-344-1230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1619413853251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health