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Individual
KELLY BUCKINGHAM
Active
Individual
KELLY BUCKINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
340
WY
1041C0700X
Clinical Social Worker
4975
ND
1041C0700X
Clinical Social Worker
Primary
634
WY
Other
Enumeration date
03/16/2010
Last updated
05/21/2021
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