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Individual

MRS. ANGELA K KELLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
822 WASHINGTON ST, MONTPELIER, ID 83254-1423
(208) 847-4464
Mailing address
1675 FOXMORE ST, POCATELLO, ID 83204-4677
(208) 317-2347

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW-35978
ID

Other

Enumeration date
05/28/2012
Last updated
08/05/2016
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