Organization
THE KELLEY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JANE KELLEY LCSW (PRESIDENT)
(414) 271-9272
Entity
Organization
Contact information
Practice address
1216 N PROSPECT AVE, MILWAUKEE, WI 53202-3014
(414) 271-9272
(414) 271-1299
Mailing address
1216 N PROSPECT AVE, MILWAUKEE, WI 53202-3014
(414) 271-9272
(414) 271-1299
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000044264
MEDICARE NUMBER
WI
01
—
281076
VALUEOPTIONS PROVIDER
WI
Enumeration date
04/17/2007
Last updated
04/20/2008
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