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NPI Code Detail

MEDICARE: COLBY LYNN KELLEY LSW

MEDICARE: COLBY LYNN KELLEY LSW
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 Worker150.112789IL

General Provider Information

NPI Number : 1790462117
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLBY LYNN KELLEY LSW
Provider Business Mailing Address
First Line : 515 N JEFFERSON AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63103-3000
Country : US
Telephone Number : 314-482-0765
Fax Number : 314-289-6543
Provider Business Practice Location Address
First Line : 515 N JEFFERSON AVE
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63103-3000
Country : US
Telephone Number : 314-482-0765
Fax Number : 314-289-6543
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2023
Last Update Date : 04/06/2026

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Directions to “ COLBY LYNN KELLEY LSW” Practice Location

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