Provider Demographics
NPI:1225867344
Name:KELTON, MICHELLLE
Entity type:Individual
Prefix:
First Name:MICHELLLE
Middle Name:
Last Name:KELTON
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 1:506 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-2312
Mailing Address - Country:US
Mailing Address - Phone:216-253-8114
Mailing Address - Fax:
Practice Address - Street 1:506 CLINTON ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-2312
Practice Address - Country:US
Practice Address - Phone:216-253-8114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging