Provider Demographics
NPI:1548378193
Name:DANE-KELLOGG, JOAN E (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:E
Last Name:DANE-KELLOGG
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 1:700 COMMERCIAL CT STE 201
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3675
Mailing Address - Country:US
Mailing Address - Phone:912-349-9729
Mailing Address - Fax:912-777-6162
Practice Address - Street 1:304A COMMERCIAL DRIVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406
Practice Address - Country:US
Practice Address - Phone:912-351-0325
Practice Address - Fax:912-351-9986
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0007371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S33051Medicare UPIN
80BBDKNMedicare ID - Type Unspecified