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General NPI Number Information
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NPI Number | 1619422771
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Entity Type | Individual
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Provider Name | KELLY LINDENBAUM
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Gender | Female
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Dates
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Enumeration Date | 08/18/2016
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Last Update Date | 01/01/2024
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Provider Practice Location Address
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Address Line | 5455 SHERIDAN RD STE LL10
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City | KENOSHA
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State | WI
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Zip | 53140-3752
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Country | US
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Telephone | 262-909-0356
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Fax | 262-551-3911
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Provider Business Mailing Address
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Address Line | 5556 31ST AVE
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City | KENOSHA
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State | WI
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Zip | 53144-2804
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Country | US
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Telephone | 262-909-0356
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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 | 8701
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 556-228
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8701-123
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License Number State | WI
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