Provider Demographics
NPI:1194205641
Name:HANSEN, KELSEY JOY (LSW)
Entity Type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:JOY
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MISS
Other - First Name:KELSEY
Other - Middle Name:JOY
Other - Last Name:REESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19069 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAYMOND
Mailing Address - State:OH
Mailing Address - Zip Code:43067-9788
Mailing Address - Country:US
Mailing Address - Phone:937-243-8734
Mailing Address - Fax:
Practice Address - Street 1:525 METRO PL N STE 300
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-5320
Practice Address - Country:US
Practice Address - Phone:855-289-1722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OHS.2106088104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator