Individual
CHRISTOPHER LYLE IVAN KELLOGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA
Contact information
Practice address
1 SAINT VINCENTS DR, SAN RAFAEL, CA 94903-1504
(415) 507-4299
(415) 491-0842
Mailing address
1 SAINT VINCENTS DR, SAN RAFAEL, CA 94903-1504
(415) 507-4299
(415) 491-0842
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
01/16/2014
Last updated
01/16/2014
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