Individual
DR. KELLY M CHAMPION
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
4820 MORTENSEN ROAD, SUITE 102, AMES, IA 50014-5531
(781) 552-6500
(888) 859-4941
Mailing address
4820 MORTENSEN ROAD, SUITE 102, AMES, IA 50014-5531
(781) 552-6500
(888) 859-4941
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
07388
IA
103TC0700X
Clinical Psychologist
8774
MA
103TC2200X
Clinical Child & Adolescent Psychologist
07388
IA
103TC2200X
Clinical Child & Adolescent Psychologist
8774
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
$$$$$$$$$
SOCIAL
—
Enumeration date
09/10/2007
Last updated
05/28/2020
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