Individual
CARRIE L KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC, SACIT
Contact information
Practice address
W4051 COUNTY ROAD NN, ELKHORN, WI 53121-4338
(262) 741-3200
(262) 741-3217
Mailing address
PO BOX 1005, ELKHORN, WI 53121-1005
(262) 741-3200
(262) 741-3217
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
4558-125
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1821263724
—
WI
05
—
30604011
—
KY
Enumeration date
04/23/2008
Last updated
04/12/2012
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