Individual
KELLY HALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7840 WASHINGTON AVE, KANSAS CITY, KS 66112-2152
(913) 563-4553
Mailing address
7840 WASHINGTON AVE, KANSAS CITY, KS 66112-2152
(913) 563-4553
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
017
KS
104100000X
Social Worker
Primary
5014
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
48-0576044
—
KS
Enumeration date
10/09/2018
Last updated
10/09/2018
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