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NPI Code Detail

MEDICARE: KELSEY LYNNE SANDELLA MSW, SWC

MEDICARE: KELSEY LYNNE SANDELLA MSW, SWC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1205568250
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY LYNNE SANDELLA MSW, SWC
Provider Business Mailing Address
First Line : 7131 YAMPA RIVER HTS
Second Line :
City : FOUNTAIN
State : CO
Zip : 80817-1570
Country : US
Telephone Number : 719-985-1325
Fax Number :
Provider Business Practice Location Address
First Line : 4360 MONTEBELLO DR STE 400
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-7224
Country : US
Telephone Number : 719-649-9778
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2022
Last Update Date : 06/28/2022

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