Active NPI
Kathleen Ann Kelly
- Clinical Social Worker
- Bloomington, IN
National Provider Identifier
1821305525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 34006805A
- Practice address
- 517 N Walnut St
Bloomington, IN 47404-3845 - Phone
- (812) 219-6202
- NPI assigned
- Sep 2, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 34006805A | IN | Primary |
Addresses
Primary practice location
517 N Walnut St
Bloomington, IN 47404-3845
Mailing address
3042 Dollsberry LN
Nashville, IN 47448-8228
Phone (812) 219-6206
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34006805A | IN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1459728000000",
"number": "1821305525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3042 DOLLSBERRY LN",
"city": "NASHVILLE",
"state": "IN",
"postal_code": "474488228",
"telephone_number": "812-219-6206"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "517 N WALNUT ST",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474043845",
"telephone_number": "812-219-6202"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLY",
"first_name": "KATHLEEN",
"middle_name": "ANN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-09-02",
"last_updated": "2016-04-04",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "IN",
"license": "34006805A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.