Doctor Name: | MRS. KELLEY B CONLEY |
NPI Number: | 1457417479 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW |
License Number: | |
Business Practice Address: | 146 Gooding St La Salle, IL - 613012424 |
Business Phone Number: | 8152244522 |
Business Fax Number: | 8152942243 |
Mailing Address: | 808 Michigan Ave, MENDOTA |
State: | IL |
Postal Code: | 613421514 |
Phone Number: | 8158301997 |
Fax Number: | 8155381999 |
NPI Enumeration Date: | 12/28/2006 |
NPI Last Update Date: | 05/02/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |