Individual
MICHELE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
295 CENTENNIAL STREET, BLACKFOOT, ID 83221-2700
(208) 680-4086
Mailing address
295 CENTENNIAL ST, BLACKFOOT, ID 83221-3963
(208) 680-4086
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-30317
ID
Other
Enumeration date
08/01/2013
Last updated
04/16/2014
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