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General NPI Number Information
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NPI Number | 1700235298
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Entity Type | Individual
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Provider Name | KELSI VI KENNISON M.S., LMFT
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Gender | Female
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Dates
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Enumeration Date | 06/06/2016
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Last Update Date | 11/01/2018
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Provider Practice Location Address
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Address Line | 213 N ANKENY BLVD STE 100
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City | ANKENY
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State | IA
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Zip | 50023-1749
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Country | US
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Telephone | 515-337-1764
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Fax |
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Provider Business Mailing Address
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Address Line | 8350 EP TRUE PKWY UNIT 3106
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City | WEST DES MOINES
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State | IA
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Zip | 50266-8374
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Country | US
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Telephone | 309-798-9924
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 208.000394
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License Number State | IL
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