Provider Demographics
NPI:1194361758
Name:SAUL, KELLY JEAN (MA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:JEAN
Last Name:SAUL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59594 94TH ST
Mailing Address - Street 2:
Mailing Address - City:SABULA
Mailing Address - State:IA
Mailing Address - Zip Code:52070-9305
Mailing Address - Country:US
Mailing Address - Phone:563-241-8534
Mailing Address - Fax:
Practice Address - Street 1:250 20TH AVE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-2503
Practice Address - Country:US
Practice Address - Phone:563-243-2124
Practice Address - Fax:563-243-2190
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)