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NPI Code Detail

MEDICARE: GRIFFIN KELLY

MEDICARE: GRIFFIN KELLY
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
11041C0700XClinical Social Worker095431IA

General Provider Information

NPI Number : 1205482932
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRIFFIN KELLY
Provider Business Mailing Address
First Line : 2240 9TH ST
Second Line :
City : CORALVILLE
State : IA
Zip : 52241-1575
Country : US
Telephone Number : 319-800-5564
Fax Number :
Provider Business Practice Location Address
First Line : 2240 9TH ST
Second Line :
City : CORALVILLE
State : IA
Zip : 52241-1575
Country : US
Telephone Number : 319-800-5564
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2019
Last Update Date : 01/26/2026

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Directions to “ GRIFFIN KELLY ” Practice Location

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