Individual
WENDY CARROLL KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1320 WISCONSIN AVE, RACINE, WI 53403-1978
(262) 687-2699
Mailing address
1737 PATRIOT WAY, RACINE, WI 53406-2730
(262) 884-7137
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
WI
Other
Enumeration date
08/17/2010
Last updated
08/17/2010
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