Individual
KIMBERLY SUE KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
630 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5299
(208) 535-0505
Mailing address
630 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5299
(208) 535-0505
Taxonomy
Speciality
Code
Description
License number
State
103TR0400X
Rehabilitation Psychologist
Primary
—
—
Other
Enumeration date
10/14/2010
Last updated
10/14/2010
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