Provider Demographics
NPI:1013531318
Name:KALEY, NANCY MARIE (LADC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:MARIE
Last Name:KALEY
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13479 CARMODY DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-6718
Mailing Address - Country:US
Mailing Address - Phone:612-250-0075
Mailing Address - Fax:
Practice Address - Street 1:202 1ST ST S
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:MN
Practice Address - Zip Code:56069-1602
Practice Address - Country:US
Practice Address - Phone:952-303-9585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-02
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN300369101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty