Provider Demographics
NPI:1376228486
Name:PRICKETT, KELSEY RAE (LMSW)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:RAE
Last Name:PRICKETT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-3264
Mailing Address - Country:US
Mailing Address - Phone:319-750-1626
Mailing Address - Fax:
Practice Address - Street 1:1517 SUMMER ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-3264
Practice Address - Country:US
Practice Address - Phone:319-750-1626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1192441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical