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NPI Code Detail

MEDICARE: KELSEY IANNITELLO CSW

MEDICARE: KELSEY IANNITELLO CSW
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
1104100000XSocial Worker
21041C0700XClinical Social Worker259836KY

General Provider Information

NPI Number : 1285205674
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY IANNITELLO CSW
Provider Business Mailing Address
First Line : 121 E 2ND ST STE 401
Second Line :
City : OWENSBORO
State : KY
Zip : 42303-4125
Country : US
Telephone Number : 270-240-1785
Fax Number : 270-240-1861
Provider Business Practice Location Address
First Line : 121 E 2ND ST STE 401
Second Line :
City : OWENSBORO
State : KY
Zip : 42303-4125
Country : US
Telephone Number : 270-240-1785
Fax Number : 270-240-1861
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2021
Last Update Date : 03/13/2025

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Directions to “ KELSEY IANNITELLO CSW” Practice Location

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