Provider Demographics
NPI:1639859465
Name:BREDEHOEFT, KELLI NICOLE (LMSW)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:NICOLE
Last Name:BREDEHOEFT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1708 NW PRAIRIE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-4829
Mailing Address - Country:US
Mailing Address - Phone:319-404-1492
Mailing Address - Fax:
Practice Address - Street 1:1708 NW PRAIRIE CREEK DR
Practice Address - Street 2:
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-4829
Practice Address - Country:US
Practice Address - Phone:319-404-1492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-18
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00750104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker