Provider Demographics
NPI:1326683434
Name:WHALEN, KELSEY RAE (LMFT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:RAE
Last Name:WHALEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 MAIN ST STE 305
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4099
Mailing Address - Country:US
Mailing Address - Phone:608-305-4903
Mailing Address - Fax:
Practice Address - Street 1:444 MAIN ST STE 305
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4099
Practice Address - Country:US
Practice Address - Phone:608-305-4903
Practice Address - Fax:608-218-3820
Is Sole Proprietor?:No
Enumeration Date:2019-11-12
Last Update Date:2022-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI718-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100211286Medicaid