Healthcare Provider Details

I. General information

NPI: 1508093758
Provider Name (Legal Business Name): KELLY JACQUELINE HULL MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 06/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23837 WELBY WAY
WEST HILLS CA
91307-3014
US

IV. Provider business mailing address

23837 WELBY WAY
WEST HILLS CA
91307-3014
US

V. Phone/Fax

Practice location:
  • Phone: 818-497-7891
  • Fax:
Mailing address:
  • Phone: 818-497-7891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: