Individual
DEBRA J KELLOGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1415 W DAKOTA PKWY, WILLISTON, ND 58801-3885
(701) 572-6757
(701) 744-3532
Mailing address
913 12TH ST SE, WATFORD CITY, ND 58854-6711
(701) 842-6226
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
264
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
58577
—
ND
Enumeration date
02/22/2007
Last updated
07/09/2007
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