Provider Demographics
NPI:1568948248
Name:KICKBUSH, KELSEY SWENSEN (MSW)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:SWENSEN
Last Name:KICKBUSH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 FERRY ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-3047
Mailing Address - Country:US
Mailing Address - Phone:657-446-9898
Mailing Address - Fax:
Practice Address - Street 1:2201 FERRY ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-3047
Practice Address - Country:US
Practice Address - Phone:765-446-9898
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-16
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical