Provider Demographics
NPI:1568941979
Name:ASTLEY, KESLIE LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:KESLIE
Middle Name:LYNN
Last Name:ASTLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KESLIE
Other - Middle Name:LYNN
Other - Last Name:HEBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:916 E HANDEL ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-7648
Mailing Address - Country:US
Mailing Address - Phone:970-305-7947
Mailing Address - Fax:
Practice Address - Street 1:3525 E LOUISE DR STE 500
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6305
Practice Address - Country:US
Practice Address - Phone:208-706-7050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-361051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical