Individual
SHELLY L KINNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
18 2ND AVE SE, STANLEY, ND 58784-0039
(701) 628-2925
(701) 628-3175
Mailing address
PO BOX 39, 18 2ND AVE SE, STANLEY, ND 58784-0039
(701) 628-2925
(701) 628-3175
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1464982
—
ND
01
—
3608
SW LICENSE
ND
Enumeration date
10/20/2015
Last updated
10/20/2015
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