MEDICARE: KELSEY EDWARDS

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
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1639692270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY EDWARDS

Provider Business Mailing Address
First Line	:	2005 ASBURY RD
Second Line	:
City	:	DUBUQUE
State	:	IA
Zip	:	52001-3042
Country	:	US
Telephone Number	:	563-583-7357
Fax Number	:	888-243-3455

Provider Business Practice Location Address
First Line	:	106 N JACKSON ST
Second Line	:
City	:	MT PLEASANT
State	:	IA
Zip	:	52641-2047
Country	:	US
Telephone Number	:	319-385-7177
Fax Number	:	319-385-9567

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2017
Last Update Date	:	11/29/2022

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