Provider Demographics
NPI:1104645324
Name:KELLY, JANDI (MS, PHD)
Entity type:Individual
Prefix:DR
First Name:JANDI
Middle Name:
Last Name:KELLY
Suffix:
Gender:F
Credentials:MS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:754 NW BROADWAY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-2776
Mailing Address - Country:US
Mailing Address - Phone:541-668-7558
Mailing Address - Fax:
Practice Address - Street 1:754 NW BROADWAY ST STE 100
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2776
Practice Address - Country:US
Practice Address - Phone:541-668-7558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach