Individual
KELLY M LEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
645 S ROGERS ST, BLOOMINGTON, IN 47403-2353
(812) 339-1691
Mailing address
645 S ROGERS ST, BLOOMINGTON, IN 47403-2353
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
33008773A
IN
1041C0700X
Clinical Social Worker
Primary
34010708A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
26-3890332
—
IN
Enumeration date
05/20/2021
Last updated
07/21/2025
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