Provider Demographics
NPI:1447447941
Name:CRITTENDEN, KELLEY KAY (LAC)
Entity type:Individual
Prefix:MS
First Name:KELLEY
Middle Name:KAY
Last Name:CRITTENDEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:7170 E MCDONALD DR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-5408
Mailing Address - Country:US
Mailing Address - Phone:480-998-7009
Mailing Address - Fax:480-998-1200
Practice Address - Street 1:2634 N 49TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-1644
Practice Address - Country:US
Practice Address - Phone:602-852-3825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist