MEDICARE: KELSEY YALE MSW, LICSW

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	30312	MN

General Provider Information

NPI Number	:	1902424153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY YALE MSW, LICSW

Provider Business Mailing Address
First Line	:	1600 S LANE ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98144-2810
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1823 25TH AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-1803
Country	:	US
Telephone Number	:	126-757-3333
Fax Number	:

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

Provider Enumeration Date	:	07/13/2020
Last Update Date	:	04/17/2026

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