Provider Demographics
NPI:1235648064
Name:SHEPLEY, KELSEY (MT-BC/L)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:SHEPLEY
Suffix:
Gender:F
Credentials:MT-BC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1998 30TH AVE S APT 104
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-8914
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:523 DEMERS AVE
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4528
Practice Address - Country:US
Practice Address - Phone:701-740-8103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-25
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2016-05225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND2016-05OtherLICENSE TO PRACTICE MUSIC THERAPY
12566OtherMUSIC THERAPIST- BOARD CERTIFIED