Provider Demographics
NPI:1588236095
Name:KELTNER, KYLA MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:MARIE
Last Name:KELTNER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KYLA
Other - Middle Name:MARIE
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:223 S WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-6974
Mailing Address - Country:US
Mailing Address - Phone:515-233-1122
Mailing Address - Fax:
Practice Address - Street 1:223 S WALNUT AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-6974
Practice Address - Country:US
Practice Address - Phone:515-233-1122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0952991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical