Individual
OWEN KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
950 S SNODGRASS DR, PALMER, AK 99645-9750
(907) 373-4732
(907) 746-4750
Mailing address
PO BOX 876741, WASILLA, AK 99687-6741
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
01/20/2025
Last updated
01/21/2025
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