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NPI Code Detail

MEDICARE: LISA KELLY M.ED., ED.S.

MEDICARE: LISA KELLY M.ED., ED.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TS0200XSchool Psychologist21158298OH

General Provider Information

NPI Number : 1457728628
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA KELLY M.ED., ED.S.
Provider Business Mailing Address
First Line : 11083 HAMILTON AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45231-1409
Country : US
Telephone Number : 513-674-4200
Fax Number :
Provider Business Practice Location Address
First Line : 11765 HAMILTON AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45231-1128
Country : US
Telephone Number : 513-825-7070
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2015
Last Update Date : 08/24/2015

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