Provider Demographics
NPI:1518949932
Name:KIELY, LYNN (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:
Last Name:KIELY
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 GROVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-3504
Mailing Address - Country:US
Mailing Address - Phone:612-870-8728
Mailing Address - Fax:
Practice Address - Street 1:233 GROVELAND AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3504
Practice Address - Country:US
Practice Address - Phone:612-870-8728
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 2972103TC1900X
MNLICSW 2329104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker