Healthcare Provider Details

I. General information

NPI: 1639091754
Provider Name (Legal Business Name): KELSEY STAPPERT PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 N 15TH AVE STE 101
BOZEMAN MT
59715-3289
US

IV. Provider business mailing address

1276 N 15TH AVE STE 101
BOZEMAN MT
59715-3289
US

V. Phone/Fax

Practice location:
  • Phone: 406-586-3301
  • Fax:
Mailing address:
  • Phone: 406-586-3301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY-PSY-LIC-6171
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: