Provider Demographics
NPI:1487135703
Name:RATZ, KELSEY CHARLENE (ADULT FAMILY HOME)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:CHARLENE
Last Name:RATZ
Suffix:
Gender:F
Credentials:ADULT FAMILY HOME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3542 S 92ND ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53228-1575
Mailing Address - Country:US
Mailing Address - Phone:414-236-5075
Mailing Address - Fax:866-408-1418
Practice Address - Street 1:6644 N 58TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-5934
Practice Address - Country:US
Practice Address - Phone:414-732-4614
Practice Address - Fax:866-408-1418
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0015213253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care