Provider Demographics
NPI:1548519150
Name:HELLAND, KELLY MARIE (LICSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:MARIE
Last Name:HELLAND
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29295 MORNINGSIDE COURT
Mailing Address - Street 2:
Mailing Address - City:LINDSTROM
Mailing Address - State:MN
Mailing Address - Zip Code:55045-9385
Mailing Address - Country:US
Mailing Address - Phone:651-329-4002
Mailing Address - Fax:
Practice Address - Street 1:29295 MORNINGSIDE COURT
Practice Address - Street 2:
Practice Address - City:LINDSTROM
Practice Address - State:MN
Practice Address - Zip Code:55045-9385
Practice Address - Country:US
Practice Address - Phone:651-329-4002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN97221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical