Provider Demographics
NPI:1053036285
Name:LOPEZ-RAM, KELSHA
Entity type:Individual
Prefix:
First Name:KELSHA
Middle Name:
Last Name:LOPEZ-RAM
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 1:1318 83RD STREET CT E
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404-5907
Mailing Address - Country:US
Mailing Address - Phone:253-653-8278
Mailing Address - Fax:
Practice Address - Street 1:3837 S 12TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2138
Practice Address - Country:US
Practice Address - Phone:888-971-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAB61562663106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst