Individual
BETHANY S. KELLOGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, LCSW
Contact information
Practice address
2100 GOSHEN RD, FORT WAYNE, IN 46808-1493
(574) 936-9646
(574) 936-9646
Mailing address
2621 E JEFFERSON ST, WARSAW, IN 46580-3880
(574) 267-7169
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
10/10/2017
Last updated
02/25/2021
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