# MR. KELLY G BRODERSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1467702746
- **Gender:** Man

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 104100000X | Social Worker | 6364 | KY | — |
| 1041C0700X | Clinical Social Worker | 3992 | KY | Yes |

## Other

- **Enumeration date:** 09/14/2012
- **Last updated:** 05/09/2019