Provider Demographics
NPI:1124735071
Name:LELAND, KELSEY W (MS)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:W
Last Name:LELAND
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4902 DUNMAN AVE
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2719
Mailing Address - Country:US
Mailing Address - Phone:530-521-9290
Mailing Address - Fax:
Practice Address - Street 1:4902 DUNMAN AVE
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2719
Practice Address - Country:US
Practice Address - Phone:530-521-9290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist