Provider Demographics
NPI:1508983065
Name:BREWER, KELLY ANN (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ANN
Last Name:BREWER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MRS
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:YEAGLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:1860 HWY 93 NORTH
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2627
Mailing Address - Country:US
Mailing Address - Phone:406-201-9803
Mailing Address - Fax:
Practice Address - Street 1:1860 HWY 93 NORTH
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901
Practice Address - Country:US
Practice Address - Phone:406-201-9803
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA123419104100000X
MT869LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker