Provider Demographics
NPI:1457417479
Name:CONLEY, KELLEY B (MSW)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:B
Last Name:CONLEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MENDOTA
Mailing Address - State:IL
Mailing Address - Zip Code:61342-1514
Mailing Address - Country:US
Mailing Address - Phone:815-830-1997
Mailing Address - Fax:815-538-1999
Practice Address - Street 1:146 GOODING ST
Practice Address - Street 2:
Practice Address - City:LA SALLE
Practice Address - State:IL
Practice Address - Zip Code:61301-2424
Practice Address - Country:US
Practice Address - Phone:815-224-4522
Practice Address - Fax:815-294-2243
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional