Healthcare Provider Details

I. General information

NPI: 1376270520
Provider Name (Legal Business Name): KELSEY DAWSON PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2022
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1654 S HILAND DR
FRANKFORT IN
46041-6826
US

IV. Provider business mailing address

1654 S HILAND DR
FRANKFORT IN
46041-6826
US

V. Phone/Fax

Practice location:
  • Phone: 216-392-9330
  • Fax:
Mailing address:
  • Phone: 216-392-9330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number20043518A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number20043518A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number20043518A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number20043518A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number20043518A
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number20043518A
License Number StateIN
# 7
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number20043518A
License Number StateIN
# 8
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number20043518A
License Number StateIN
# 9
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number20043518A
License Number StateIN
# 10
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20043518A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: