Individual
JENNIFER A KELLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
790 RIDGE RD, LACKAWANNA, NY 14218-1629
(716) 828-7550
Mailing address
790 RIDGE RD, LACKAWANNA, NY 14218-1629
(716) 828-7550
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
373H00000X
Day Training/Habilitation Specialist
—
—
Other
Enumeration date
12/04/2017
Last updated
12/08/2017
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