Provider Demographics
NPI:1285205674
Name:IANNITELLO, KELSEY (CSW)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:IANNITELLO
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:MELTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3919 BENTTREE DR APT A
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-8612
Mailing Address - Country:US
Mailing Address - Phone:270-702-4556
Mailing Address - Fax:
Practice Address - Street 1:3919 BENTTREE DR APT A
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-8612
Practice Address - Country:US
Practice Address - Phone:270-702-4556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker