Healthcare Provider Details

I. General information

NPI: 1639976343
Provider Name (Legal Business Name): KELLY HALLADAY LPC-IT, SAC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2025
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 MILWAUKEE ST
DELAFIELD WI
53018-1517
US

IV. Provider business mailing address

2940 CLEARWATER LN APT 205
WAUKESHA WI
53189-6893
US

V. Phone/Fax

Practice location:
  • Phone: 262-290-5338
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number20787-130
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8831-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: