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General NPI Number Information
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NPI Number | 1932327756
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Entity Type | Individual
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Provider Name | JACQUELYN A KELLEY L.C.S.W.
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Gender | Female
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Dates
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Enumeration Date | 04/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2419 COIT RD STE C
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City | PLANO
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State | TX
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Zip | 75075-3731
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Country | US
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Telephone | 469-667-9413
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Fax | 469-384-4922
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Provider Business Mailing Address
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Address Line | 6804 WILD RIDGE CT
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City | PLANO
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State | TX
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Zip | 75024-7467
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Country | US
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Telephone | 469-667-9413
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Fax | 469-384-4922
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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 | 38134
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License Number State | TX
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