Kelsey Wilson, LICSW, LISW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

3374 Issued in NE

Practice address

3410 Futures Dr
South Sioux City, NE 68776-3917

Phone

(402) 412-7242

Fax

(712) 252-5920

NPI assigned

Jul 31, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IA, NE2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Siouxland Community Health Center

  • Federally Qualified Health Center (FQHC)
  • South Sioux City, NE
  • NPI 1912378480
  Medicare reassignment NPD
• Siouxland Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Sioux City, IA
  • NPI 1558355305
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1690761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690761600000",
    "number": "1285315333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 DIVISION ST",
            "city": "JEFFERSON",
            "state": "SD",
            "postal_code": "570382039",
            "telephone_number": "712-898-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3410 FUTURES DR",
            "city": "SOUTH SIOUX CITY",
            "state": "NE",
            "postal_code": "687763917",
            "telephone_number": "402-412-7242",
            "fax_number": "712-252-5920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KELSEY",
        "credential": "LICSW, LISW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-31",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IA",
            "license": "095606",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NE",
            "license": "3374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Traelle Williams
• Maria Wilmes
• Amanda Star Wilson
• Hailey Wilson
• Julie Wilson
• Michele Wilson
• Nelson Wilson
• Carrie Ann Winterringer, RBT
• Ashlea Wolfe
• Donna Wolff

• Clinical Social Worker in South Sioux City, NE
• Providers in South Sioux City, NE by specialty
• Clinical Social Worker in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.