Provider Demographics
NPI:1184438152
Name:KELL, JENNIFER DAWN (LAAC-15555)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DAWN
Last Name:KELL
Suffix:
Gender:F
Credentials:LAAC-15555
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:SITKA COUNSELING AND PREVENTION
Mailing Address - Street 2:113 METLAKATLA ST
Mailing Address - City:SITKA
Mailing Address - State:AK
Mailing Address - Zip Code:99835
Mailing Address - Country:US
Mailing Address - Phone:907-747-3636
Mailing Address - Fax:907-747-2702
Practice Address - Street 1:SITKA COUNSELING AND PREVENTION
Practice Address - Street 2:113 METLAKATLA ST
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835
Practice Address - Country:US
Practice Address - Phone:907-747-3636
Practice Address - Fax:907-747-2702
Is Sole Proprietor?:No
Enumeration Date:2025-02-01
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15555101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)