Individual
KELLY A MUNDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34007123A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000930972
ANTHEM
IN
05
—
100240880
—
IN
01
—
12777494
CAQH
—
01
—
168890
SIHO
IN
01
—
839090011
MEDICARE
IN
Enumeration date
08/27/2014
Last updated
03/24/2016
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