=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124632229
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KELLI RUE LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2020
-----------------------------------------------------
Last Update Date | 12/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 700 19TH ST S
-----------------------------------------------------
City | BIRMINGHAM
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35233-1927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 205-933-8101
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 806 EDISON AVE
-----------------------------------------------------
City | MUSCLE SHOALS
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35661-1810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-330-3462
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 5688C
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 4489G
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------