Provider Demographics
NPI:1457535353
Name:NEWELL, KELLY ROXANNE (MED)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ROXANNE
Last Name:NEWELL
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:ROXANNE
Other - Last Name:SEGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1133 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225
Mailing Address - Country:US
Mailing Address - Phone:360-676-2164
Mailing Address - Fax:
Practice Address - Street 1:1133 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5055
Practice Address - Country:US
Practice Address - Phone:360-676-2164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00059527101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health