Individual
MS. ELISEHA ENNEE KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
1812 E MADISON ST, SEATTLE, WA 98122-2843
(206) 850-6428
Mailing address
4651 S FRONTENAC ST, SEATTLE, WA 98118-3627
(206) 850-6428
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA 60253578
WA
Other
Enumeration date
03/20/2012
Last updated
03/20/2012
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