Active NPI
Susan Kellie
- Counselor
- Richland, WA
National Provider Identifier
1194265090
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- CG60172334
- Practice address
- 2139 Van Giesen St
Richland, WA 99354-2746 - Phone
- (509) 946-4645
- Fax
- (509) 946-1398
- NPI assigned
- Feb 27, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | CG60172334 | WA | Primary |
Addresses
Primary practice location
2139 Van Giesen St
Richland, WA 99354-2746
Mailing address
5301 Tieton Dr Ste C
Yakima, WA 98908-3479
Phone (509) 965-7100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CG60172334 | WA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1488153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1488153600000",
"number": "1194265090",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5301 TIETON DR STE C",
"city": "YAKIMA",
"state": "WA",
"postal_code": "989083479",
"telephone_number": "509-965-7100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2139 VAN GIESEN ST",
"city": "RICHLAND",
"state": "WA",
"postal_code": "993542746",
"telephone_number": "509-946-4645",
"fax_number": "509-946-1398"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLIE",
"first_name": "SUSAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-02-27",
"last_updated": "2017-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WA",
"license": "CG60172334",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richland, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.