Individual
KELLY KELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC-IT
Contact information
Practice address
6333 ODANA RD STE 20, MADISON, WI 53719-1130
(608) 270-2511
(608) 270-0467
Mailing address
6333 ODANA RD STE 20, MADISON, WI 53719-1130
(608) 270-2511
(608) 270-0467
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3227 - 226
WI
Other
Enumeration date
09/19/2016
Last updated
01/03/2019
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