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General NPI Number Information
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NPI Number | 1295307593
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Entity Type | Individual
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Provider Name | KELLY MCCOLLAM
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Gender | Female
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Dates
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Enumeration Date | 07/15/2021
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 4861 DUCK CREEK RD
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City | CINCINNATI
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State | OH
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Zip | 45227-1421
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Country | US
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Telephone | 513-832-2884
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Fax |
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Provider Business Mailing Address
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Address Line | 623 TRADITION RDG
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City | CINCINNATI
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State | OH
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Zip | 45245-3505
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Country | US
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Telephone | 513-659-8770
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-24-75545
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License Number State | OH
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