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General NPI Number Information
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NPI Number | 1518450493
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Entity Type | Individual
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Provider Name | KELSEY LYNN CONRAD BSW, LSW
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Gender | Female
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 06/14/2018
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Provider Practice Location Address
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Address Line | 6200 ROCKSIDE WOODS BLVD N STE 305
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City | INDEPENDENCE
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State | OH
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Zip | 44131-2343
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Country | US
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Telephone | 440-815-1570
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Fax |
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Provider Business Mailing Address
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Address Line | 4238 MCGREGOR AVE APT 3
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City | NEWBURGH HTS
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State | OH
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Zip | 44105-3260
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Country | US
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Telephone | 216-338-0368
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | S.1802131
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License Number State | OH
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