Provider Demographics
NPI:1255109286
Name:KEALY, KAYLIN
Entity type:Individual
Prefix:
First Name:KAYLIN
Middle Name:
Last Name:KEALY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAYLIN
Other - Middle Name:
Other - Last Name:GRAFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGSW, LADC
Mailing Address - Street 1:1071 MN-15 PLAZA
Mailing Address - Street 2:15
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1071 MN-15 PLAZA
Practice Address - Street 2:15
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350
Practice Address - Country:US
Practice Address - Phone:320-484-4610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN324311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical