Provider Demographics
NPI:1124747738
Name:HARLAND, KELSEY B
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:B
Last Name:HARLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:CASCADE
Mailing Address - State:MT
Mailing Address - Zip Code:59421-0105
Mailing Address - Country:US
Mailing Address - Phone:406-231-8537
Mailing Address - Fax:
Practice Address - Street 1:7 PENNY LANE
Practice Address - Street 2:
Practice Address - City:CASCADE
Practice Address - State:MT
Practice Address - Zip Code:59421
Practice Address - Country:US
Practice Address - Phone:406-231-8537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services