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General NPI Number Information
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NPI Number | 1104092014
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Entity Type | Individual
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Provider Name | KELLEY J POLK LIMHP,LADC
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Gender | Female
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Dates
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Enumeration Date | 05/01/2008
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 507 7TH ST STE 213
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City | SIOUX CITY
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State | IA
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Zip | 51101-1125
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Country | US
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Telephone | 712-870-1445
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Fax | 712-248-8866
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Provider Business Mailing Address
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Address Line | 507 7TH ST STE 213
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City | SIOUX CITY
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State | IA
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Zip | 51101-1125
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Country | US
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Telephone | 712-870-1445
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Fax | 712-248-8866
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 001074
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 965
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1139
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License Number State | NE
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