Basic Information
Provider Information
NPI: 1427453448
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHILLING
FirstName: KELSI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: IADC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 651 6TH ST SE
Address2: APT 8
City: MASON CITY
State: IA
PostalCode: 504014169
CountryCode: US
TelephoneNumber: 3194644654
FaxNumber:  
Practice Location
Address1: 320 N EISENHOWER AVE
Address2:  
City: MASON CITY
State: IA
PostalCode: 504011521
CountryCode: US
TelephoneNumber: 6412437221
FaxNumber: 6414240783
Other Information
ProviderEnumerationDate: 11/03/2014
LastUpdateDate: 11/03/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YA0400X14079IAY Behavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)

No ID Information.


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