Provider Demographics
NPI:1790177780
Name:KELLOGG, MEG
Entity Type:Individual
Prefix:
First Name:MEG
Middle Name:
Last Name:KELLOGG
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 1:44 CANDLEWOOD GDNS
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-2638
Mailing Address - Country:US
Mailing Address - Phone:315-591-6983
Mailing Address - Fax:
Practice Address - Street 1:8282 WILLETT PKWY
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-1306
Practice Address - Country:US
Practice Address - Phone:315-857-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator