Basic Information
| Provider Information | |||||||||
| NPI: | 1417297649 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STUERKE | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | MELISSA | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JONES | ||||||||
| OtherFirstName: | KELLY | ||||||||
| OtherMiddleName: | MELISSA | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1004 WILSHIRE DR | ||||||||
| Address2: | |||||||||
| City: | BERTHOUD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805139372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706995123 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1440 W 29TH ST | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805382459 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9707757061 | ||||||||
| FaxNumber: | 9702928194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2013 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.