Individual
LYDIA KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
801 N WALNUT ST, CHAMPAIGN, IL 61820-3055
(217) 373-2430
Mailing address
307 NAPLES DR, RANTOUL, IL 61866-3463
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
07/14/2014
Last updated
07/14/2014
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