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General NPI Number Information
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NPI Number | 1477252955
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Entity Type | Individual
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Provider Name | JENNIFER BLANCA KELLEY MS., IN MFT
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Gender | Female
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Dates
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Enumeration Date | 02/23/2023
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Last Update Date | 02/23/2023
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Provider Practice Location Address
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Address Line | 1144 29TH AVE N
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City | SAINT CLOUD
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State | MN
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Zip | 56303-5632
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Country | US
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Telephone | 320-260-6772
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Fax | 855-291-6387
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Provider Business Mailing Address
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Address Line | PO BOX 633
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City | COLD SPRING
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State | MN
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Zip | 56320-0633
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Country | US
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Telephone | 320-260-6772
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Fax | 855-291-6387
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State | MN
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