Provider Demographics
NPI:1467199729
Name:ZURLIENE, KELLI DIANE (LCSW)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:DIANE
Last Name:ZURLIENE
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 1:13030 BUCKEYE RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-4400
Mailing Address - Country:US
Mailing Address - Phone:618-830-9319
Mailing Address - Fax:
Practice Address - Street 1:450 W 1ST ST
Practice Address - Street 2:
Practice Address - City:AVISTON
Practice Address - State:IL
Practice Address - Zip Code:62216-3440
Practice Address - Country:US
Practice Address - Phone:618-228-7615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0208431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical