Provider Demographics
NPI:1700235298
Name:KENNISON, KELSI VI (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:KELSI
Middle Name:VI
Last Name:KENNISON
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8350 EP TRUE PKWY UNIT 3106
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8374
Mailing Address - Country:US
Mailing Address - Phone:309-798-9924
Mailing Address - Fax:
Practice Address - Street 1:213 N ANKENY BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-1749
Practice Address - Country:US
Practice Address - Phone:515-337-1764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208.000394106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist