Individual
MR. KEVIN PATRICK KELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW
Contact information
Practice address
241 CLEVELAND AVE S, SUITE B3, SAINT PAUL, MN 55105-1208
(651) 698-2773
(651) 698-2776
Mailing address
241 CLEVELAND AVE S, SUITE B3, SAINT PAUL, MN 55105-1208
(651) 698-2773
(651) 698-2776
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
13200
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
502473100
—
MN
01
—
62-76668
UNITED BEHAVIORAL HEALTH
MN
01
—
91G35KE
BLUE CROSS BLUE SHIELD
MN
Enumeration date
06/16/2006
Last updated
06/07/2009
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