Provider Demographics
NPI:1992841175
Name:RATLIFF, KELLI MARIE (LSW)
Entity Type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:MARIE
Last Name:RATLIFF
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2411 SEAMAN ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605-1519
Mailing Address - Country:US
Mailing Address - Phone:419-693-1520
Mailing Address - Fax:419-693-3295
Practice Address - Street 1:2411 SEAMAN ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43605-1519
Practice Address - Country:US
Practice Address - Phone:419-693-1520
Practice Address - Fax:419-693-3295
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS00236731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical