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Individual
KELLY D EDGELL
Active
Individual
KELLY D EDGELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCDCIII
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCDCIII.081187
OH
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
02/26/2018
Last updated
11/06/2025
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