Provider Demographics
NPI:1780826289
Name:FIELDING, KELLY ROSS (PHD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ROSS
Last Name:FIELDING
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3301
Mailing Address - Country:US
Mailing Address - Phone:360-750-1575
Mailing Address - Fax:360-750-1898
Practice Address - Street 1:201 E 19TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3301
Practice Address - Country:US
Practice Address - Phone:360-750-1575
Practice Address - Fax:360-750-1898
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001690103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical