Individual
AMY KELLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4074 LUCKY LN, LEWISTON, ID 83501-7025
(208) 786-3398
Mailing address
4074 LUCKY LN, LEWISTON, ID 83501-7025
(208) 746-3398
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
LMSW35904
ID
1041C0700X
Clinical Social Worker
Primary
LCSW-38191
ID
Other
Enumeration date
06/27/2016
Last updated
09/03/2024
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