1770600264 NPI number — LAURA L GRAMLY -KELLEY L.AC, MTCM, MSW

Table of content: LAURA L GRAMLY -KELLEY L.AC, MTCM, MSW (NPI 1770600264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770600264 NPI number — LAURA L GRAMLY -KELLEY L.AC, MTCM, MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRAMLY -KELLEY
Provider First Name:
LAURA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.AC, MTCM, MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRAMLY
Provider Other First Name:
LAURA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.AC, MTCM, MSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770600264
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11008 21ST AVE SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98146-2045
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-932-6114
Provider Business Mailing Address Fax Number:
206-923-0577

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6053 CALIFORNIA AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98136-1612
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-932-6114
Provider Business Practice Location Address Fax Number:
206-923-0577
Provider Enumeration Date:
03/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC00002183 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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