Provider Demographics
NPI:1396588257
Name:TCHAMKORIYSKI, KELSEY (CLC)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:TCHAMKORIYSKI
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5845 MONASSAS RUN RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-8759
Mailing Address - Country:US
Mailing Address - Phone:501-589-5440
Mailing Address - Fax:
Practice Address - Street 1:5845 MONASSAS RUN RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-8759
Practice Address - Country:US
Practice Address - Phone:501-589-5440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH356214174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN