Provider Demographics
NPI:1871081596
Name:SELZER-KELTING, ILONA M
Entity type:Individual
Prefix:
First Name:ILONA
Middle Name:M
Last Name:SELZER-KELTING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 PINEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MORRISONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12962-9782
Mailing Address - Country:US
Mailing Address - Phone:518-563-6587
Mailing Address - Fax:
Practice Address - Street 1:37 EAGLE WAY
Practice Address - Street 2:
Practice Address - City:WEST CHAZY
Practice Address - State:NY
Practice Address - Zip Code:12992-2562
Practice Address - Country:US
Practice Address - Phone:518-563-8321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1063242103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1063242OtherPUBLIC SCHOOL TEACHER CERTIFICATE