Provider Demographics
NPI:1285315333
Name:WILSON, KELSEY (LICSW, LISW)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:LICSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:SD
Mailing Address - Zip Code:57038-2039
Mailing Address - Country:US
Mailing Address - Phone:712-898-4800
Mailing Address - Fax:
Practice Address - Street 1:3410 FUTURES DR
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3917
Practice Address - Country:US
Practice Address - Phone:402-412-7242
Practice Address - Fax:712-252-5920
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0956061041C0700X
NE33741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical