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General NPI Number Information
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NPI Number | 1861838799
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Entity Type | Individual
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Provider Name | KELLIE STRYKER LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/19/2013
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Last Update Date | 05/19/2013
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Provider Practice Location Address
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Address Line | 8905 REGENTS PARK DR #230
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City | TAMPA
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State | FL
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Zip | 33647-3081
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Country | US
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Telephone | 813-928-7288
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Fax |
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Provider Business Mailing Address
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Address Line | 3255 LAKE PADGETT DR
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City | LAND O LAKES
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State | FL
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Zip | 34639-4527
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Country | US
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Telephone | 813-928-7288
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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 | SW 8286
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License Number State | FL
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