Provider Demographics
NPI:1437715240
Name:BELL, KELLY MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:BELL
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 1:333 E WASHINGTON ST STE 2100
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-2503
Mailing Address - Country:US
Mailing Address - Phone:262-335-4600
Mailing Address - Fax:262-335-6827
Practice Address - Street 1:333 E WASHINGTON ST STE 2100
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-2503
Practice Address - Country:US
Practice Address - Phone:262-335-4600
Practice Address - Fax:262-335-6827
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI99221041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker