Provider Demographics
NPI:1023723459
Name:SHULDES, KELSEA NICOLE (LMSW)
Entity type:Individual
Prefix:MS
First Name:KELSEA
Middle Name:NICOLE
Last Name:SHULDES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 17TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-4840
Mailing Address - Country:US
Mailing Address - Phone:520-485-5902
Mailing Address - Fax:
Practice Address - Street 1:3501 W ELDER ST STE 300
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-4986
Practice Address - Country:US
Practice Address - Phone:208-286-1529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-20191104100000X
IDLMSW-42853104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker