Provider Demographics
NPI:1821773656
Name:ELEAZER, KELLIE ALLYN
Entity type:Individual
Prefix:MRS
First Name:KELLIE
Middle Name:ALLYN
Last Name:ELEAZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:A
Other - Last Name:KOGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1420 S MERIDIAN STE C
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-6914
Mailing Address - Country:US
Mailing Address - Phone:360-524-2702
Mailing Address - Fax:
Practice Address - Street 1:1420 S MERIDIAN STE C
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-6914
Practice Address - Country:US
Practice Address - Phone:360-524-2702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty