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General NPI Number Information
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NPI Number | 1053204040
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Entity Type | Individual
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Provider Name | KELLEY L KELCH LCSW, LMSW
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Gender | Female
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Dates
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Enumeration Date | 05/30/2025
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 2515 FULLER RD
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City | ANN ARBOR
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State | MI
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Zip | 48105
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Country | US
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Telephone | 734-222-8690
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Fax |
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Provider Business Mailing Address
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Address Line | 827 ASA GRAY DR APT 460
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City | ANN ARBOR
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State | MI
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Zip | 48105-3522
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Country | US
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Telephone | 734-277-3623
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801064499
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License Number State | MI
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