Provider Demographics
NPI:1447084090
Name:TRUNK, KELSEY (LCSW)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:TRUNK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:CUSHING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:75 E QUEENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MORTON
Mailing Address - State:IL
Mailing Address - Zip Code:61550-2985
Mailing Address - Country:US
Mailing Address - Phone:309-263-5565
Mailing Address - Fax:309-263-9336
Practice Address - Street 1:211 N VETERANS PKWY STE 1
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-3568
Practice Address - Country:US
Practice Address - Phone:309-663-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490268711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical