Provider Demographics
NPI:1366801979
Name:STONE, KEHLY ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:KEHLY
Middle Name:ANN
Last Name:STONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 PHAY AVE
Mailing Address - Street 2:STE B
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212
Mailing Address - Country:US
Mailing Address - Phone:719-429-7528
Mailing Address - Fax:719-372-8281
Practice Address - Street 1:1335 PHAY AVE
Practice Address - Street 2:STE B
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212
Practice Address - Country:US
Practice Address - Phone:719-445-6689
Practice Address - Fax:719-372-8281
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099253981041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14378751OtherCAQH
CO9000163735Medicaid