Provider Demographics
NPI:1316173149
Name:RAML, KELSEY A (LN RD)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:A
Last Name:RAML
Suffix:
Gender:F
Credentials:LN RD
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:A
Other - Last Name:LIKNESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LN RD
Mailing Address - Street 1:506 1ST AVE SE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-4402
Mailing Address - Country:US
Mailing Address - Phone:605-886-8482
Mailing Address - Fax:605-884-4300
Practice Address - Street 1:506 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-4402
Practice Address - Country:US
Practice Address - Phone:605-886-8482
Practice Address - Fax:605-884-4300
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0370133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0370OtherSTATE LICENSE