Provider Demographics
NPI:1881860674
Name:HOWARD, KELLIE ANN
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:ANN
Last Name:HOWARD
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 1:2318 F ST
Mailing Address - Street 2:#7
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-3570
Mailing Address - Country:US
Mailing Address - Phone:916-640-3219
Mailing Address - Fax:
Practice Address - Street 1:4240 ROCKLIN RD
Practice Address - Street 2:SUITE 5
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-2862
Practice Address - Country:US
Practice Address - Phone:916-315-0468
Practice Address - Fax:916-315-0462
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)