| NPI | 1154981769 |
|---|---|
| Former Name | KELLY LEIGH TODD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: IL 149020903) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 32880) |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2019-10-02 |