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General NPI Number Information
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NPI Number | 1316299985
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Entity Type | Individual
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Provider Name | KELLY M KOLODY LMSW
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Gender | Female
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Dates
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Enumeration Date | 10/08/2012
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Last Update Date | 03/03/2025
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Provider Practice Location Address
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Address Line | 24715 GLEN ORCHARD DR
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City | FARMINGTON HILLS
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State | MI
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Zip | 48336-1729
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Country | US
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Telephone | 586-904-1210
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Fax | 248-741-6274
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Provider Business Mailing Address
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Address Line | PO BOX 753
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City | FARMINGTON HILLS
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State | MI
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Zip | 48332-0753
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Country | US
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Telephone | 586-904-1210
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Fax | 248-741-6274
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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 | 6801094299
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License Number State | MI
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