Champion, Kelly M

Champion, Kelly M is an sole proprietor health care provider with primary practice located at 4820 Mortensen Road Suite 102, Ames IA 50014-5531. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical Child & Adolescent, Behavioral Health & Social Service Providers / Clinical. Behavioral Health & Social Service Providers / Clinical is her primary health care specialty. Champion, Kelly M can be contacted via phone (781) 552-6500.

Contact Information

Primary practice address
4820 Mortensen Road Suite 102 Ames IA 50014-5531
Phone: (781) 552-6500
Fax: (888) 859-4941
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X 8774 Massachusetts
Behavioral Health & Social Service Providers / Clinical 103TC0700X 07388 Iowa
Behavioral Health & Social Service Providers / Clinical 103TC0700X 8774 Massachusetts
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X 07388 Iowa

Profile Details

NPI number 1538354998
LBN Legal business name Champion, Kelly M
Credentials PH.D.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 10th, 2007
Last updated May 28th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1538354998 NPPES
Other $$$$$$$$$ SOCIAL

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