| Doctor Name: | KELLY DULOHERY |
| NPI Number: | 1861877490 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LICSW |
| License Number: | 20650 |
| Business Practice Address: | 1695 Lor Ray Dr North Mankato, MN - 560032804 |
| Business Phone Number: | 5073856548 |
| Business Fax Number: | |
| Mailing Address: | 1695 Lor Ray Dr, NORTH MANKATO |
| State: | MN |
| Postal Code: | 560032804 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 07/24/2015 |
| NPI Last Update Date: | 07/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 20650 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |