Provider Demographics
NPI:1881478113
Name:WIDENER, KELSEY (MSW)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:WIDENER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:ADKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:504 FREEMAN ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-4837
Mailing Address - Country:US
Mailing Address - Phone:501-545-1434
Mailing Address - Fax:
Practice Address - Street 1:185 CORNERSTONE LN
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6500
Practice Address - Country:US
Practice Address - Phone:501-525-4855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR12892-M104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker