Provider Demographics
NPI:1659939205
Name:KELLEY, JENNIFER ANN (LMSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:KELLEY
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 1:939 WATERLOO AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-1660
Mailing Address - Country:US
Mailing Address - Phone:734-652-4573
Mailing Address - Fax:734-621-4026
Practice Address - Street 1:939 WATERLOO AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-1660
Practice Address - Country:US
Practice Address - Phone:734-230-2915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801104321104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker