Individual
KELLY RENNICK O'BERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LISW
Contact information
Practice address
7755 OFFICE PLAZA DR N, SUITE 105, WEST DES MOINES, IA 50266-2339
(515) 201-0439
Mailing address
7755 OFFICE PLAZA DR N, SUITE 105, WEST DES MOINES, IA 50266-2339
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
06475
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1861757148
—
IA
Enumeration date
07/11/2012
Last updated
04/07/2017
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