Provider Demographics
NPI:1306212352
Name:HARTZFELD, KELLY (LSW)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:
Last Name:HARTZFELD
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:BODNAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:56 CLARION PLZ
Mailing Address - Street 2:SUITE 115
Mailing Address - City:CLARION
Mailing Address - State:PA
Mailing Address - Zip Code:16214-8575
Mailing Address - Country:US
Mailing Address - Phone:724-689-7438
Mailing Address - Fax:
Practice Address - Street 1:56 CLARION PLZ
Practice Address - Street 2:SUITE 115
Practice Address - City:CLARION
Practice Address - State:PA
Practice Address - Zip Code:16214-8575
Practice Address - Country:US
Practice Address - Phone:724-689-7438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW126603104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker