Individual
KELLY M STANEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 721-4581
Mailing address
1120 15TH ST # OR6000, AUGUSTA, GA 30912-0004
(706) 721-3813
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
3375-057
WI
103G00000X
Clinical Neuropsychologist
Primary
PSY004125
GA
Other
Enumeration date
06/15/2016
Last updated
08/04/2023
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