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General NPI Number Information
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NPI Number | 1902123201
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Entity Type | Individual
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Provider Name | KELLY J WEDDLE LMFT
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Gender | Female
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Dates
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Enumeration Date | 04/26/2010
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Last Update Date | 09/01/2023
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Provider Practice Location Address
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Address Line | 925 S LINCOLN BLVD
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City | HODGENVILLE
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State | KY
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Zip | 42748-1701
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Country | US
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Telephone | 844-435-0900
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Fax | 270-858-4029
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Provider Business Mailing Address
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Address Line | PO BOX 1080
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City | BURKESVILLE
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State | KY
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Zip | 42717-1080
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Country | US
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Telephone | 270-858-6655
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Fax | 270-858-4607
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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 | 276325
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License Number State | KY
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