Provider Demographics
NPI:1194193623
Name:SCHELLER, KENNETH J (LCSW)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:SCHELLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 PRAIRIEWOOD DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4625
Mailing Address - Country:US
Mailing Address - Phone:812-454-4954
Mailing Address - Fax:
Practice Address - Street 1:5201 BISHOPS BLVD S STE B
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7605
Practice Address - Country:US
Practice Address - Phone:812-454-4954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-15
Last Update Date:2022-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006131A1041C0700X
ND62261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical