Individual
KELLY BLAKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LSW
Contact information
Practice address
2478 PAINTED DESERT RUN, FORT WAYNE, IN 46808-3660
(219) 916-4732
Mailing address
2478 PAINTED DESERT RUN, FORT WAYNE, IN 46808-3660
(219) 916-4732
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
33010413A
IN
Other
Enumeration date
01/02/2025
Last updated
01/02/2025
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