Individual
KELLY CHRISTINE EDISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D
Contact information
Practice address
1301 KS HWY 264, LARNED, KS 67550-5353
(620) 285-4647
Mailing address
1301 KS HWY 264, LARNED, KS 67550-5353
(620) 285-4647
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
T-LP 1833
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
T-LP 1833
LICENSE NUMBER
KS
Enumeration date
10/13/2009
Last updated
10/13/2009
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