Healthcare Provider Details

I. General information

NPI: 1386518694
Provider Name (Legal Business Name): LILLY ANNE KELKENBERG MA, LSW, CSWC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1295 KELLY JOHNSON BLVD STE 240
COLORADO SPRINGS CO
80920-3963
US

IV. Provider business mailing address

2735 E SAN MIGUEL ST UNIT 201
COLORADO SPRINGS CO
80909-3159
US

V. Phone/Fax

Practice location:
  • Phone: 719-480-8848
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0009926667
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: