Provider Demographics
NPI:1578887667
Name:MINKSY-KELLY, DEBRA K (LCSW)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:K
Last Name:MINKSY-KELLY
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 1:7394 S HEATHERIDGE CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8317
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8800 S 102ND ST
Practice Address - Street 2:SUITE 103
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-7702
Practice Address - Country:US
Practice Address - Phone:414-858-1014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-18
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6558-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical