Provider Demographics
NPI:1891372231
Name:JOHN, KELSIE (SW)
Entity Type:Individual
Prefix:
First Name:KELSIE
Middle Name:
Last Name:JOHN
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3608
Mailing Address - Country:US
Mailing Address - Phone:304-636-9450
Mailing Address - Fax:304-636-2282
Practice Address - Street 1:971 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3608
Practice Address - Country:US
Practice Address - Phone:304-636-9450
Practice Address - Fax:304-636-2282
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00945788104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker