Provider Demographics
NPI:1811456874
Name:WALDRON, KELLI (MS, LPC)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:WALDRON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E LONGVIEW DR STE C
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-2102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 E LONGVIEW DR STE C
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-2102
Practice Address - Country:US
Practice Address - Phone:920-815-3355
Practice Address - Fax:920-239-6067
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health