Provider Demographics
NPI:1770755662
Name:KIRKPATRICK, KELLIE H (LIC AC)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:H
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 BEACON ST
Mailing Address - Street 2:#415
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-3704
Mailing Address - Country:US
Mailing Address - Phone:617-720-4242
Mailing Address - Fax:
Practice Address - Street 1:14 BEACON ST
Practice Address - Street 2:#415
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-3704
Practice Address - Country:US
Practice Address - Phone:617-720-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA348171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist