| Doctor Name: | SUSAN E KELLY |
| NPI Number: | 1003877895 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PHD, LMHC |
| License Number: | 00408 |
| Business Practice Address: | 5264 Council St Ne Ste 400 Cedar Rapids, IA - 524022471 |
| Business Phone Number: | 3193986694 |
| Business Fax Number: | 3193694673 |
| Mailing Address: | Po Box 1824, CEDAR RAPIDS |
| State: | IA |
| Postal Code: | 524061824 |
| Phone Number: | 3193694505 |
| Fax Number: | 3193694677 |
| NPI Enumeration Date: | 03/31/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | 00408 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |