Healthcare Provider Details

I. General information

NPI: 1508462631
Provider Name (Legal Business Name): KELSEY N JARVIS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 N 800 W
HYRUM UT
84319-1298
US

IV. Provider business mailing address

35 N 800 W
HYRUM UT
84319-1298
US

V. Phone/Fax

Practice location:
  • Phone: 573-823-4956
  • Fax:
Mailing address:
  • Phone: 573-823-4956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12898063-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: