Provider Information for 1861897746
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Ms. KAREN ROSE KELLY LCSW, MAC, CDCS
Sex: Female
NPI: 1861897746
Last Updated: 2020-09-18
Certification Date: 2020-09-16
Certification Date: 2020-09-16
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1861897746 | ||||||||
| Enumeration Date | 2014-11-04 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 673 MDG 5955 ZEAMER AVENUE JBER, AK 99506 United States Phone: 907-551-3782 | Fax: | ||||||||
| Primary Practice Address | 5955 ZEAMER AVE # 673MDG JBER, AK 99506-3702 United States Phone: 907-551-3782 | Fax: | ||||||||
| Secondary Practice Address(es) | 5510 N WESTFORK DR | ||||||||
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