Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | LP2116 | ME |
Y | 101YP2500X | Professional Counselor | 001832 | CT |
NPI | 1144239757 |
---|---|
Provider Name | Dr. Duane Kellogg JR. |
First Address | Fairfield, CT 06824-5120 |
Second Address | Fairfield, CT 06824-5120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 16/07/2009 |