Provider Demographics
NPI:1275706624
Name:KIESEL-WEATHERFORD, KORI KANOELANI (LCSW, DCSW, BCD)
Entity Type:Individual
Prefix:MRS
First Name:KORI
Middle Name:KANOELANI
Last Name:KIESEL-WEATHERFORD
Suffix:
Gender:F
Credentials:LCSW, DCSW, BCD
Other - Prefix:
Other - First Name:KORI
Other - Middle Name:KANOELANI
Other - Last Name:KIESEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, DCSW, BCD
Mailing Address - Street 1:1 JARRETT WHITE RD
Mailing Address - Street 2:
Mailing Address - City:TRIPLER ARMY MEDICAL CENTER
Mailing Address - State:HI
Mailing Address - Zip Code:96859-5001
Mailing Address - Country:US
Mailing Address - Phone:808-433-6661
Mailing Address - Fax:808-433-1551
Practice Address - Street 1:1 JARRETT WHITE RD
Practice Address - Street 2:
Practice Address - City:TRIPLER ARMY MEDICAL CENTER
Practice Address - State:HI
Practice Address - Zip Code:96859-5001
Practice Address - Country:US
Practice Address - Phone:808-433-6661
Practice Address - Fax:808-433-1551
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW34321041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical