Healthcare Provider Details

I. General information

NPI: 1013543396
Provider Name (Legal Business Name): KELSEY A KIDDER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELSEY A KAEFER

II. Dates (important events)

Enumeration Date: 03/18/2020
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 ELM STREET, SPOONER, WI 54801
SPOONER WI
54801
US

IV. Provider business mailing address

111 ELM STREET, SPOONER, WI 54801
SPOONER WI
54801
US

V. Phone/Fax

Practice location:
  • Phone: 715-222-7588
  • Fax:
Mailing address:
  • Phone: 715-222-7588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7713-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: