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NPI Code Detail

MEDICARE: KELLY A DEARDOFF

MEDICARE: KELLY A DEARDOFF
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2101YM0800XMental Health Counselor
3171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1780547224
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY A DEARDOFF
Provider Business Mailing Address
First Line : 149 MERCY BLVD
Second Line :
City : MOUNT ORAB
State : OH
Zip : 45154-0296
Country : US
Telephone Number : 937-712-3121
Fax Number : 937-712-3122
Provider Business Practice Location Address
First Line : 149 MERCY BLVD
Second Line :
City : MOUNT ORAB
State : OH
Zip : 45154-0296
Country : US
Telephone Number : 937-712-3121
Fax Number : 937-712-3122
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2025
Last Update Date : 12/03/2025

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Directions to “ KELLY A DEARDOFF ” Practice Location

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