Provider Demographics
NPI:1821136680
Name:MCDANELD, KELLEY BROOKE (LAC, DIPLOM, BS)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:BROOKE
Last Name:MCDANELD
Suffix:
Gender:F
Credentials:LAC, DIPLOM, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40460 HARBOR PL
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-8422
Mailing Address - Country:US
Mailing Address - Phone:970-819-6738
Mailing Address - Fax:
Practice Address - Street 1:57 10TH STREET
Practice Address - Street 2:SUITE 1A
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487
Practice Address - Country:US
Practice Address - Phone:970-819-6738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1139171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO80449OtherSLOANS LAKE PROVIDER ID #