Provider Demographics
NPI:1861728958
Name:KELLOGG, TONI MARIE (CLMT)
Entity type:Individual
Prefix:MRS
First Name:TONI
Middle Name:MARIE
Last Name:KELLOGG
Suffix:
Gender:F
Credentials:CLMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 LAZELLE
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:SD
Mailing Address - Zip Code:57785-1601
Mailing Address - Country:US
Mailing Address - Phone:605-720-1295
Mailing Address - Fax:
Practice Address - Street 1:928 LAZELLE ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:SD
Practice Address - Zip Code:57785-1674
Practice Address - Country:US
Practice Address - Phone:605-720-1295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD500225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist