Kelly Pelong

Primary specialty

Social WorkerTaxonomy code 104100000X

License

6802072118 Issued in MI

Practice address

1705 S Saginaw Rd
Midland, MI 48640-5633

Phone

(989) 835-4041

NPI assigned

Jul 11, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1499731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1499731200000",
    "number": "1508388596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5113 SWEDE AVE",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486423197",
            "telephone_number": "989-860-2758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 S SAGINAW RD",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486405633",
            "telephone_number": "989-835-4041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELONG",
        "first_name": "KELLY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-11",
        "last_updated": "2017-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "6802072118",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38-2912348",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peaceful Pride Counseling LLC
• Courtney Pearson, MD
• Greg Peek
• Christopher Odell Peeler, LBSW
• Kathryn Joan Pelliccia
• Kristin R. Penberthy, LMSW, QMHP, QIDP
• Samuel John Penkala, OTRL
• Courtney Pennington
• Danita Lucette Peoples-Peterson, MD
• Kendall Rose Perdue

• Social Worker in Midland, MI
• Providers in Midland, MI by specialty
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.