Provider Demographics
NPI:1750996708
Name:ANDERSON, KELSEY (LISW, LCSW)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:
Credentials:LISW, LCSW
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:GUYETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:520 10TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1910
Mailing Address - Country:US
Mailing Address - Phone:319-688-3333
Mailing Address - Fax:
Practice Address - Street 1:520 10TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1910
Practice Address - Country:US
Practice Address - Phone:319-688-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0257951041C0700X
IA0998981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical