Provider Demographics
NPI:1013020635
Name:FINCH, KELLY (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:FINCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 SPRING CREEK RD
Mailing Address - Street 2:STE 19
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-1158
Mailing Address - Country:US
Mailing Address - Phone:815-222-9485
Mailing Address - Fax:
Practice Address - Street 1:4320 SPRING CREEK RD
Practice Address - Street 2:STE 19
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-1158
Practice Address - Country:US
Practice Address - Phone:815-222-9485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490089581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK13667Medicare PIN
ILK13667Medicare UPIN