MEDICARE: SARA KELLY PLLC

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
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1134077969
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARA KELLY PLLC

Provider Business Mailing Address
First Line	:	3136 10TH AVE S APT 4
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1765
Country	:	US
Telephone Number	:	631-965-7057
Fax Number	:

Provider Business Practice Location Address
First Line	:	3136 10TH AVE S APT 4
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55407-1765
Country	:	US
Telephone Number	:	631-965-7057
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	SARA KELLY
Credential	:	LICSW
Telephone Number	:	631-965-7057

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/25/2026

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