Provider Demographics
NPI:1831626233
Name:KELLY, ALYSSA L (ND)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:L
Last Name:KELLY
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 NE 60TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5513
Mailing Address - Country:US
Mailing Address - Phone:630-306-6726
Mailing Address - Fax:
Practice Address - Street 1:509 OLIVE WAY STE 1315
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1771
Practice Address - Country:US
Practice Address - Phone:206-382-9977
Practice Address - Fax:888-519-9390
Is Sole Proprietor?:No
Enumeration Date:2017-05-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60758539175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath