Individual
KENNETH KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1118 W AZTEC BLVD, AZTEC, NM 87410-1818
(505) 334-3695
Mailing address
212 N VALLEY BLVD, BLOOMFIELD, NM 87413-5749
(602) 999-3618
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
—
AZ
Other
Enumeration date
04/13/2007
Last updated
08/18/2010
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