Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
KELLY DOUGLAS
Active Sole ProprietorKELLY DOUGLAS is a Emotionally Disturbed Children Residential Treatment healthcare provider located in JEFFERSON, Wisconsin. NPI 1093541831 is currently active in the NPPES registry. Verify at CMS.
Emotionally Disturbed Children Residential Treatment · JEFFERSON, WI
Registration Details
- NPI Number
- 1093541831
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Sep 9, 2024 (1.9740466766651 yrs)
- Last Updated
- Sep 9, 2024
- Sole Proprietor
- Yes
Practice Information
- Address
-
910 HILLSIDE DRJEFFERSON, WI, 535491823Browse WI providers · Browse ZIP 53549
- Phone
- 9206500027
- Primary Specialty
-
Emotionally Disturbed Children Residential Treatment
320900000X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.