Individual
KELLY RAE HENDRICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
230 PARK ST, WAUTOMA, WI 54982-9031
(920) 787-6550
Mailing address
PO BOX 1230, WAUTOMA, WI 54982-1230
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
03/23/2022
Last updated
03/23/2022
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