Provider Demographics
NPI:1801114871
Name:KELLY A. KALT, MSW, LCSW, INC.
Entity type:Organization
Organization Name:KELLY A. KALT, MSW, LCSW, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINCIAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KALT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:815-229-7102
Mailing Address - Street 1:1639 N ALPINE RD
Mailing Address - Street 2:SUITE #403
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-1449
Mailing Address - Country:US
Mailing Address - Phone:815-229-7102
Mailing Address - Fax:815-229-7108
Practice Address - Street 1:1639 N ALPINE RD
Practice Address - Street 2:SUITE #403
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-1449
Practice Address - Country:US
Practice Address - Phone:815-229-7102
Practice Address - Fax:815-229-7108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty