Provider Demographics
NPI:1770075830
Name:HUGHES, KELLEN (PHD)
Entity type:Individual
Prefix:
First Name:KELLEN
Middle Name:
Last Name:HUGHES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:KEOKUK
Mailing Address - State:IA
Mailing Address - Zip Code:52632-5034
Mailing Address - Country:US
Mailing Address - Phone:309-333-1886
Mailing Address - Fax:
Practice Address - Street 1:1000 GRAND AVE
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-5034
Practice Address - Country:US
Practice Address - Phone:309-333-1886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool