Provider Demographics
NPI:1881882579
Name:FITZGERALD, KELLY ALLISON (MS)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ALLISON
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ALLISON
Other - Last Name:DOLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 R AVE
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2276
Mailing Address - Country:US
Mailing Address - Phone:360-708-9946
Mailing Address - Fax:
Practice Address - Street 1:1601 R AVE
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2276
Practice Address - Country:US
Practice Address - Phone:360-708-9946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60305072101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health