Provider Demographics
NPI:1972048155
Name:BLOMEKE, KELSEY (PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:BLOMEKE
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 DEPOT DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-1615
Mailing Address - Country:US
Mailing Address - Phone:360-610-7515
Mailing Address - Fax:
Practice Address - Street 1:721 DEPOT DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-1615
Practice Address - Country:US
Practice Address - Phone:360-610-7515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-27
Last Update Date:2023-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005590103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical