Healthcare Provider Details

I. General information

NPI: 1982534285
Provider Name (Legal Business Name): KELLY D SHEA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 N RAILROAD ST
SUMNER IA
50674-1126
US

IV. Provider business mailing address

515 N RAILROAD ST
SUMNER IA
50674-1126
US

V. Phone/Fax

Practice location:
  • Phone: 641-373-1375
  • Fax:
Mailing address:
  • Phone: 641-373-1375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KELLY DIANNE SHEA
Title or Position: CEO/THERAPIST
Credential: LMFT
Phone: 641-373-1375