Provider Demographics
NPI:1780840041
Name:PATTERSON, KELLI MARCELLE
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:MARCELLE
Last Name:PATTERSON
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 1:3839 DANBURY WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-6662
Mailing Address - Country:US
Mailing Address - Phone:925-383-6054
Mailing Address - Fax:
Practice Address - Street 1:3839 DANBURY WAY
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-6662
Practice Address - Country:US
Practice Address - Phone:925-383-6054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health