Individual
CODY J. KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AAC
Contact information
Practice address
1820 E 17TH ST STE 330, IDAHO FALLS, ID 83404-6400
(208) 410-8695
Mailing address
1820 E 17TH ST STE 330, IDAHO FALLS, ID 83404-6400
(208) 410-8695
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/11/2022
Last updated
06/04/2025
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