Provider Demographics
NPI:1396046934
Name:MOLZHON, KELLI J
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:J
Last Name:MOLZHON
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 1:4324 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-1209
Mailing Address - Country:US
Mailing Address - Phone:509-315-8682
Mailing Address - Fax:
Practice Address - Street 1:1020 S 7TH AVE
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-5794
Practice Address - Country:US
Practice Address - Phone:509-545-6506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-13
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60145794101YM0800X
WALH60194320101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health