Provider Demographics
NPI:1548661879
Name:KAMINSKI, KELLY RAE (MS, NCSP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:RAE
Last Name:KAMINSKI
Suffix:
Gender:F
Credentials:MS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11127 10TH AVENUE CT E
Mailing Address - Street 2:APARTMENT A303
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98445-7076
Mailing Address - Country:US
Mailing Address - Phone:412-848-9471
Mailing Address - Fax:
Practice Address - Street 1:559 KING ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29403-7504
Practice Address - Country:US
Practice Address - Phone:843-277-0493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool