Healthcare Provider Details

I. General information

NPI: 1700535127
Provider Name (Legal Business Name): JODI KELLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 N MERIDIAN ST
INDIANAPOLIS IN
46208-5728
US

IV. Provider business mailing address

1575 DR MLK JR ST
INDIANAPOLIS IN
46202-2295
US

V. Phone/Fax

Practice location:
  • Phone: 317-634-6341
  • Fax:
Mailing address:
  • Phone: 317-264-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34007992A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: