Provider Demographics
NPI:1417390972
Name:BREIDIGAN, KELLEY JO (MSW, LISW)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:JO
Last Name:BREIDIGAN
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 HIGHBANKS VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-9251
Mailing Address - Country:US
Mailing Address - Phone:614-561-9867
Mailing Address - Fax:877-450-4276
Practice Address - Street 1:128S MAIN ST
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-1409
Practice Address - Country:US
Practice Address - Phone:614-561-9867
Practice Address - Fax:877-450-4276
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker