Basic Information
| Provider Information | |||||||||
| NPI: | 1083157028 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIG | ||||||||
| FirstName: | KELLEY | ||||||||
| MiddleName: | JEAN | ||||||||
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| OtherLastName: | WILLIG | ||||||||
| OtherFirstName: | KELLEY-JEAN | ||||||||
| OtherMiddleName: | M. | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 614 | ||||||||
| Address2: | |||||||||
| City: | HOPKINSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422410614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708862205 | ||||||||
| FaxNumber: | 2708860392 | ||||||||
| Practice Location | |||||||||
| Address1: | 735 NORTH DR | ||||||||
| Address2: | |||||||||
| City: | HOPKINSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422402620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708865163 | ||||||||
| FaxNumber: | 2708865178 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2016 | ||||||||
| LastUpdateDate: | 05/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 254061 | KY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.