Provider Demographics
NPI:1578674099
Name:KITZELMAN, CHRISTEL LYNN (MSW)
Entity Type:Individual
Prefix:MS
First Name:CHRISTEL
Middle Name:LYNN
Last Name:KITZELMAN
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 1:113 COMANCHE RD
Mailing Address - Street 2:
Mailing Address - City:FORT MEADE
Mailing Address - State:SD
Mailing Address - Zip Code:57741-1002
Mailing Address - Country:US
Mailing Address - Phone:605-347-2511
Mailing Address - Fax:605-718-1094
Practice Address - Street 1:1755 MOON MEADOWS DR APT 427
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8564
Practice Address - Country:US
Practice Address - Phone:605-718-1095
Practice Address - Fax:605-718-1094
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD15081041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical