Provider Demographics
NPI:1770986069
Name:CLEMENTS, KELLY (PSYD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:CLEMENTS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:VALDIVIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3434 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-4155
Practice Address - Country:US
Practice Address - Phone:608-443-5480
Practice Address - Fax:608-443-5554
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist