Individual
KELLY FALLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LISW-S, LCSW
Contact information
Practice address
4220 HOUSTON RD, ERLANGER, KY 41018-3402
(502) 262-2887
Mailing address
8665 TUDOR CT, CINCINNATI, OH 45242-7836
(513) 771-7239
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
254010
KY
1041C0700X
Clinical Social Worker
Primary
254010
KY
1041C0700X
Clinical Social Worker
I.1201146-SUPV
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0176667
—
OH
05
—
7100660700
—
KY
Enumeration date
03/18/2015
Last updated
12/18/2020
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