Healthcare Provider Details

I. General information

NPI: 1447104906
Provider Name (Legal Business Name): KELLI MARIE SCHAEFER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELLI MARIE SCOTT

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 LOCUST ST
DES MOINES IA
50309-3718
US

IV. Provider business mailing address

612 LOCUST ST
DES MOINES IA
50309-3718
US

V. Phone/Fax

Practice location:
  • Phone: 515-290-2195
  • Fax:
Mailing address:
  • Phone: 515-290-2195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number136770
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: