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Individual
KELLY J BURG
Active
Individual
KELLY J BURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW,SAC
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
15508-131
WI
101YM0800X
Mental Health Counselor
Primary
8996-123
WI
104100000X
Social Worker
129139-121
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1639421373
—
WI
Enumeration date
10/04/2012
Last updated
04/22/2026
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