Provider Demographics
NPI:1972071140
Name:HERIGSTAD-FRANZ, KELLY HOFFMAN
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:HOFFMAN
Last Name:HERIGSTAD-FRANZ
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 1:780 NW 25TH ST APT 16
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-5445
Mailing Address - Country:US
Mailing Address - Phone:650-862-8434
Mailing Address - Fax:
Practice Address - Street 1:780 NW 25TH ST APT 16
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-5445
Practice Address - Country:US
Practice Address - Phone:650-862-8434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst