Individual
KELSEY WENDLAND-MOORE
Active
Individual
KELSEY WENDLAND-MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSCSW, LCSW
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
10472
KS
1041C0700X
Clinical Social Worker
05315
KS
1041C0700X
Clinical Social Worker
Primary
19947
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100098080A
—
KS
01
—
100098080C
SED WAIVER
KS
Enumeration date
06/30/2017
Last updated
07/20/2022
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