| Doctor Name: | KELLY M. VALLANGO |
| NPI Number: | 1154690758 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | EDS NCSP |
| License Number: | 4144 |
| Business Practice Address: | 48 Eb Saunders Way Clarksburg, WV - 263021370 |
| Business Phone Number: | 3046246554 |
| Business Fax Number: | 3046245223 |
| Mailing Address: | Po Box 1370, CLARKSBURG |
| State: | WV |
| Postal Code: | 263021370 |
| Phone Number: | 3046246554 |
| Fax Number: | 3046245223 |
| NPI Enumeration Date: | 12/28/2011 |
| NPI Last Update Date: | 12/28/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | 4144 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |