Provider Demographics
NPI:1013543396
Name:KIDDER, KELSEY A (LPC)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:A
Last Name:KIDDER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:A
Other - Last Name:KAEFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:SIREN
Mailing Address - State:WI
Mailing Address - Zip Code:54872-0309
Mailing Address - Country:US
Mailing Address - Phone:715-349-7069
Mailing Address - Fax:888-625-8634
Practice Address - Street 1:300 S 6TH ST
Practice Address - Street 2:
Practice Address - City:DEPERE
Practice Address - State:WI
Practice Address - Zip Code:54115-1214
Practice Address - Country:US
Practice Address - Phone:920-336-8960
Practice Address - Fax:833-581-5765
Is Sole Proprietor?:No
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7713-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health