Kelsey Rae Gravelle, SUDP LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW61677731 Issued in WA

Practice address

900 Fir St
Longview, WA 98632-2544

Phone

(360) 575-3316

NPI assigned

Feb 23, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other names 1

• Kelsey Rae Delagrange Former name

Medicare fee-for-service enrollment

Enrolled in TX

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 1

Specialty

Clinical Social Worker

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cowlitz Indian TribeGroup PAC ID 8820030133, 26 clinicians

Practice addresses (Care Compare)

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.

• Cowlitz Indian Tribe

  • Clinic/Center
  • Longview, WA
  • NPI 1740562909

  TX

  Medicare reassignment Care Compare group NPD
• Cowlitz Indian Tribe

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Vancouver, WA
  • NPI 1538412630
  NPD
• Cowlitz Indian Tribe

  • Public Health & General Preventive Medicine Physician
  • Longview, WA
  • NPI 1619194123
  NPD (past)
• Cowlitz Indian Tribe

  • General Practice Physician
  • Longview, WA
  • NPI 1851328447

  Addiction (Substance Use Disorder)

  NPD (past)

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

{
    "created_epoch": "1487808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746662400000",
    "number": "1952840944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2429",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986328486",
            "telephone_number": "360-353-9422",
            "fax_number": "360-423-7813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 FIR ST",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322544",
            "telephone_number": "360-575-3316"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7700 NE 26th Ave",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986650672",
            "country_code": "US",
            "telephone_number": "360-397-8228",
            "fax_number": "360-353-9440",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "PO Box 2429",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "WA",
            "postal_code": "986328486",
            "country_code": "US",
            "telephone_number": "360-353-9494",
            "fax_number": "360-353-9440",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "922 Fir St",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "WA",
            "postal_code": "986322525",
            "country_code": "US",
            "telephone_number": "360-353-9442 x2566",
            "fax_number": "360-353-9440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAVELLE",
        "first_name": "KELSEY",
        "middle_name": "RAE",
        "credential": "SUDP LICSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-23",
        "last_updated": "2025-05-08",
        "certification_date": "2025-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CO60714593",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW61677731",
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELSEY",
            "last_name": "DELAGRANGE",
            "middle_name": "RAE",
            "credential": "LICSWA SUDP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Marie A. Grant, RPH
• Nicole Dominique Grant, DMD
• Nova Ray Grant, BA
• Hannah Grasser
• Leilani Grasser, MSW
• Laurie Elizabeth Graves, PT, DPT
• Amy R Greeley, LMP
• Joshua William Green, M.A.
• Teresa Duarte Green, MD
• Tosha Greene

• Clinical Social Worker in Longview, WA
• Providers in Longview, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.