| Doctor Name: | JILLIAN ANGELINE KELSEY-BERRIDGE |
| NPI Number: | 1033402581 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | BS, PLADC |
| License Number: | P-931 |
| Business Practice Address: | Hwy 77/75 Winnebago, NE - 68071 |
| Business Phone Number: | 4028782480 |
| Business Fax Number: | 4028782204 |
| Mailing Address: | Po Box A, Hwy 77/75 WINNEBAGO |
| State: | NE |
| Postal Code: | 68071 |
| Phone Number: | 4028782480 |
| Fax Number: | 4028782204 |
| NPI Enumeration Date: | 05/17/2011 |
| NPI Last Update Date: | 05/17/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | P-931 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NE |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |