Provider Demographics
NPI:1801458575
Name:CARROLL, KELSEY MARIE (MSW, CSW-PIP, QMHP)
Entity type:Individual
Prefix:MS
First Name:KELSEY
Middle Name:MARIE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:MSW, CSW-PIP, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5101 E ROSA PARKS PL STE 101
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-3091
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:510 MAIN AVE STE 10
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-2010
Practice Address - Country:US
Practice Address - Phone:605-865-4105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker