Provider Demographics
NPI:1285446674
Name:KLEIN, KELSEY MARIE
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:MARIE
Last Name:KLEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4730 SYDNEY LN APT 102
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-8485
Mailing Address - Country:US
Mailing Address - Phone:270-316-7924
Mailing Address - Fax:
Practice Address - Street 1:8595 IN-37
Practice Address - Street 2:SUITE C
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586
Practice Address - Country:US
Practice Address - Phone:812-215-5584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY259167104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker