Theresa Waurzyniak Kelly, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801018578 Issued in MI

Practice address

10785 S Saginaw St
BLDG. E, Ste. a
Grand Blanc, MI 48439-7003

Phone

(810) 695-0055

Fax

(810) 695-6813

NPI assigned

Feb 17, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1487289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487289600000",
    "number": "1720527146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12141 TOWNLINE RD",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484391659",
            "telephone_number": "810-513-9017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10785 S SAGINAW ST",
            "address_2": "BLDG. E, STE. A",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484397003",
            "telephone_number": "810-695-0055",
            "fax_number": "810-695-6813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "THERESA",
        "middle_name": "WAURZYNIAK",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-17",
        "last_updated": "2017-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801018578",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elissa Keller
• Teresa Lynn Keller, PTA
• Kellogg Speech Language Learning Services
• Kathryn Kellogg
• Kristin Marie Kelly, PT
• Veronica Kelly, M.A.
• Nicole Kemp
• Anne Elise Kender, DPT
• Seaera Sueann Kennedy
• Jennifer Lynn Kent-Bryant, LMSW

• Clinical Social Worker in Grand Blanc, MI
• Providers in Grand Blanc, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 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.