Provider Demographics
NPI:1598177057
Name:DAVIS, KELSEY
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:WOLFE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:610 E WASHINGTON ST
Mailing Address - Street 2:APT. 1
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-2218
Mailing Address - Country:US
Mailing Address - Phone:765-891-1372
Mailing Address - Fax:
Practice Address - Street 1:940 LASLEY DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-1480
Practice Address - Country:US
Practice Address - Phone:888-714-1927
Practice Address - Fax:765-482-7462
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker