Provider Demographics
NPI:1366740649
Name:KUEHL, KELLY L (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:L
Last Name:KUEHL
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:L
Other - Last Name:SIMMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:N14W23777 STONE RIDGE DR STE 290
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1140
Mailing Address - Country:US
Mailing Address - Phone:414-667-5809
Mailing Address - Fax:262-393-2462
Practice Address - Street 1:N14W23777 STONE RIDGE DR STE 290
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1140
Practice Address - Country:US
Practice Address - Phone:414-667-5809
Practice Address - Fax:262-393-2462
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8096-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical