Provider Demographics
NPI:1740349992
Name:BITEL, KELLY ANN (LISW)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANN
Last Name:BITEL
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:COAL VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61240-9106
Mailing Address - Country:US
Mailing Address - Phone:309-558-8170
Mailing Address - Fax:
Practice Address - Street 1:805 W 35TH ST STE 100
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-5807
Practice Address - Country:US
Practice Address - Phone:563-468-2309
Practice Address - Fax:563-445-1604
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA052681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA70340OtherWELLMARK BCBS
IA70340OtherWELLMARK BCBS