Provider Demographics
NPI:1942727540
Name:TOLLEFSON, KELSEY L (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:L
Last Name:TOLLEFSON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 S TYLER ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:MN
Mailing Address - Zip Code:56178-9487
Mailing Address - Country:US
Mailing Address - Phone:320-297-0526
Mailing Address - Fax:
Practice Address - Street 1:408 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-2664
Practice Address - Country:US
Practice Address - Phone:507-337-0556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN236241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical