Individual
SHANNON MICHELLE KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
650 S CENTER ST, BEAVER DAM, WI 53916-2804
(920) 212-7820
(608) 720-1719
Mailing address
650 S CENTER ST, BEAVER DAM, WI 53916-2804
(920) 212-7820
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
MSW
WI
Other
Enumeration date
05/19/2022
Last updated
05/19/2022
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