Healthcare Provider Details

I. General information

NPI: 1649261538
Provider Name (Legal Business Name): KELLI L WRIGHT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6488 CHINOOK ST
BONNERS FERRY ID
83805-7515
US

IV. Provider business mailing address

6488 CHINOOK ST
BONNERS FERRY ID
83805-7515
US

V. Phone/Fax

Practice location:
  • Phone: 208-267-8710
  • Fax: 208-267-8719
Mailing address:
  • Phone: 208-267-8710
  • Fax: 208-267-8719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-27372
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: