Provider Demographics
NPI:1669144606
Name:KELLEY, JOHANNA EILEEN (LCSW, LSCSW)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:EILEEN
Last Name:KELLEY
Suffix:
Gender:F
Credentials:LCSW, LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 W 75TH ST # 401
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66208-3503
Mailing Address - Country:US
Mailing Address - Phone:816-388-0370
Mailing Address - Fax:
Practice Address - Street 1:2108 W 75TH ST # 401
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-3503
Practice Address - Country:US
Practice Address - Phone:816-388-0370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-28
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS063751041C0700X
MO20230440191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical