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General NPI Number Information
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NPI Number | 1013531318
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Entity Type | Individual
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Provider Name | NANCY MARIE KALEY LADC
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Gender | Female
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Dates
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Enumeration Date | 06/02/2020
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Last Update Date | 06/02/2020
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Provider Practice Location Address
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Address Line | 202 1ST ST S
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City | MONTGOMERY
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State | MN
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Zip | 56069-1602
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Country | US
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Telephone | 952-303-9585
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Fax |
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Provider Business Mailing Address
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Address Line | 13479 CARMODY DR
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-6718
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Country | US
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Telephone | 612-250-0075
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 300369
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License Number State | MN
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