Individual
JUDY A KANELOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
EXECUTIVE DIRECTOR
Contact information
Practice address
1251 W BROADWAY ST STE A, MONTICELLO, IN 47960-1880
(574) 218-0926
(574) 583-2600
Mailing address
1251 W BROADWAY ST STE A, MONTICELLO, IN 47960-1880
(574) 218-0926
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
20-014239
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
82-1347916
—
IN
Enumeration date
12/22/2020
Last updated
12/22/2020
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