Provider Demographics
NPI:1033907787
Name:KOLODZINSKI, KELLY (PHD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:KOLODZINSKI
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988 HASTINGS CT
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-7007
Mailing Address - Country:US
Mailing Address - Phone:414-331-8626
Mailing Address - Fax:
Practice Address - Street 1:2745 W LAYTON AVE STE 102
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53221-2651
Practice Address - Country:US
Practice Address - Phone:414-331-8626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath