MEDICARE: KELLIE DRYDEN LCSW

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	3832	KY

General Provider Information

NPI Number	:	1790106888
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLIE DRYDEN LCSW

Provider Business Mailing Address
First Line	:	280 PASADENA DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-2925
Country	:	US
Telephone Number	:	859-278-1316
Fax Number	:	859-276-3847

Provider Business Practice Location Address
First Line	:	424 LEWIS HARGETT CIR STE 200
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-3688
Country	:	US
Telephone Number	:	859-806-9455
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2013
Last Update Date	:	04/18/2023

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