Provider Demographics
NPI:1851864359
Name:SPALLONE, KELLY J (LMSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:SPALLONE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 TRIANGLE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-7955
Mailing Address - Country:US
Mailing Address - Phone:517-375-6550
Mailing Address - Fax:
Practice Address - Street 1:86 TRIANGLE LAKE RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-7955
Practice Address - Country:US
Practice Address - Phone:734-726-0048
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801103848104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker