Provider Demographics
NPI:1912385550
Name:REDFOOT, KELLI
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:REDFOOT
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 1:3124 WILMINGTON RD STE 304
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1100
Mailing Address - Country:US
Mailing Address - Phone:724-967-3757
Mailing Address - Fax:724-662-7208
Practice Address - Street 1:3124 WILMINGTON RD STE 304
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1100
Practice Address - Country:US
Practice Address - Phone:724-967-3757
Practice Address - Fax:724-662-7208
Is Sole Proprietor?:No
Enumeration Date:2015-05-15
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PAPC009054101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health