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NPI Code Detail

MEDICARE: KELLY JO KEGERREIS MSW

MEDICARE: KELLY JO KEGERREIS MSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker60910901WA
2101YA0400XAddiction (Substance Use Disorder) Counselor61297573WA

General Provider Information

NPI Number : 1063092682
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY JO KEGERREIS MSW
Provider Business Mailing Address
First Line : 812 S WALNUT ST
Second Line :
City : SPOKANE
State : WA
Zip : 99204-3326
Country : US
Telephone Number : 509-624-3251
Fax Number :
Provider Business Practice Location Address
First Line : 1508 W 6TH AVE
Second Line :
City : SPOKANE
State : WA
Zip : 99204-3409
Country : US
Telephone Number : 509-624-5228
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2021
Last Update Date : 01/15/2026

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