Provider Demographics
NPI:1750966859
Name:WEGENER, KELSEY LEE (MSW, LISW)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:LEE
Last Name:WEGENER
Suffix:
Gender:F
Credentials:MSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 HUNTER AVE APT B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-3081
Mailing Address - Country:US
Mailing Address - Phone:518-229-9333
Mailing Address - Fax:
Practice Address - Street 1:5354 N HIGH ST STE 206
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1274
Practice Address - Country:US
Practice Address - Phone:614-948-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical