Individual
MR. KELLAN JACE STACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2441 SHOOTING STAR WAY, EVANS, CO 80620-9243
(970) 689-6388
Mailing address
2441 SHOOTING STAR WAY, EVANS, CO 80620-9243
(970) 689-6388
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CSW.09930278
CO
Other
Enumeration date
12/19/2018
Last updated
07/01/2025
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