MEDICARE: DANIELLE N KELSEY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	2023000905	MO

General Provider Information

NPI Number	:	1043925829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE N KELSEY LCSW

Provider Business Mailing Address
First Line	:	3101 LUSK DR STE 112
Second Line	:
City	:	NEOSHO
State	:	MO
Zip	:	64850-2010
Country	:	US
Telephone Number	:	417-596-2415
Fax Number	:

Provider Business Practice Location Address
First Line	:	3101 LUSK DR STE 112
Second Line	:
City	:	NEOSHO
State	:	MO
Zip	:	64850-2010
Country	:	US
Telephone Number	:	417-596-2415
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2023
Last Update Date	:	04/06/2026

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