Provider Demographics
NPI:1669875167
Name:FENTON, KELSEY CAROLINE (LCSW)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:CAROLINE
Last Name:FENTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:CAROLINE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SSW
Mailing Address - Street 1:75 W 100 S STE 200
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-5842
Mailing Address - Country:US
Mailing Address - Phone:435-243-0241
Mailing Address - Fax:
Practice Address - Street 1:75 W 100 S STE 200
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-5842
Practice Address - Country:US
Practice Address - Phone:801-828-7594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
UT9512633-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator