KELLIE H MEDENDORP LSW NPI 1588163158

NPI Information

NPI: 1588163158
Provider Name: KELLIE H MEDENDORP, LSW
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

PECOS Registration: Yes

Address:
1035 VIRGINIA DR STE 130
FORT WASHINGTON, PA
ZIP 19034
Phone: (610) 745-4717
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Kellie H Medendorp, LSW is an addiction (substance use disorder) counselor in Fort Washington, PA. Kellie H Medendorp, LSW NPI is 1588163158. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1035 VIRGINIA DR STE 130
FORT WASHINGTON, PA
ZIP 19034-103
Phone: (610) 745-4717

The NPI 1588163158 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 2/8/2018 and was last updated on 2/8/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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