Provider Demographics
NPI:1598392508
Name:KELSCH, BAILY
Entity Type:Individual
Prefix:
First Name:BAILY
Middle Name:
Last Name:KELSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 726
Mailing Address - Street 2:
Mailing Address - City:LINTON
Mailing Address - State:ND
Mailing Address - Zip Code:58552-0726
Mailing Address - Country:US
Mailing Address - Phone:701-254-4502
Mailing Address - Fax:
Practice Address - Street 1:100 NW 4TH ST.
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:ND
Practice Address - Zip Code:58552
Practice Address - Country:US
Practice Address - Phone:701-254-4502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1462984Medicaid