Provider Demographics
NPI:1740790187
Name:GROCHALA, KELLI (CADC)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:GROCHALA
Suffix:
Gender:
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 E 3RD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-4805
Mailing Address - Country:US
Mailing Address - Phone:515-287-8255
Mailing Address - Fax:
Practice Address - Street 1:130 E 3RD ST STE 1
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-4805
Practice Address - Country:US
Practice Address - Phone:515-287-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17067101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)