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General NPI Number Information
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NPI Number | 1306037551
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Entity Type | Individual
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Provider Name | KELLY KRISTINE MANSON LMSW
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Gender | Female
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Dates
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Enumeration Date | 08/05/2007
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Last Update Date | 06/13/2022
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Provider Practice Location Address
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Address Line | 6405 MIDDLEBELT RD
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City | ROMULUS
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State | MI
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Zip | 48174-2036
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Country | US
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Telephone | 734-344-0069
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Fax |
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Provider Business Mailing Address
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Address Line | 22849 SHERRY DR
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City | BROWNSTOWN
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State | MI
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Zip | 48134-9064
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Country | US
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Telephone | 734-552-0992
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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 | 6801089395
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License Number State | MI
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