Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Kellan Jace Stack, LCSW

Individual provider Clinical Social Worker · NPI 1114499811

Mr. Kellan Jace Stack, LCSW is a Clinical Social Worker in Evans, Colorado. Qualified in 2018, 8 years ago. Licensed in Colorado.

Years since qualifying
8
Licensed in
CO
In the registry since
2018
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

2441 Shooting Star Way
Evans, CO 80620-9243
Phone: (970) 689-6388
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence CSW.09930278 (CO)

Record details

NPI number1114499811
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCSW
Sole proprietorNo
NPI enumeratedDecember 19, 2018
Last updated in NPPESJuly 1, 2025
Certification dateJuly 1, 2025
Mailing address2441 Shooting Star Way, Evans, CO 80620-9243

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Accepts Medicare assignment Not indicated

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