Provider Demographics
NPI:1043457203
Name:FIRLUS, KELLY R (SW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:R
Last Name:FIRLUS
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:R
Other - Last Name:LUBICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SW
Mailing Address - Street 1:JUNEAU COUNTY DEPT OF HUMAN SERVICES
Mailing Address - Street 2:200 HICKORY ST
Mailing Address - City:MAUSTON
Mailing Address - State:WI
Mailing Address - Zip Code:53948
Mailing Address - Country:US
Mailing Address - Phone:608-847-2400
Mailing Address - Fax:608-847-9599
Practice Address - Street 1:JUNEAU COUNTY DEPT OF HUMAN SERVICES
Practice Address - Street 2:200 HICKORY ST
Practice Address - City:MAUSTON
Practice Address - State:WI
Practice Address - Zip Code:53948
Practice Address - Country:US
Practice Address - Phone:608-847-2400
Practice Address - Fax:608-847-9599
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6748-120104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker