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MR. KELLAN JACE STACK LCSW
NPI 1114499811
Social Worker - Clinical in Evans, CO

Active since December 19, 2018PECOS Enrolled
2441 SHOOTING STAR WAY, EVANS, CO 80620(970) 689-6388 Get Directions Write a Review

NPPES record last updated: July 1, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jul 1, 2025, Dec 19, 2018 (2 updates tracked since 2018).

About Mr. Kellan Jace Stack Lcsw NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. KELLAN JACE STACK LCSW (NPI 1114499811) is an individual clinical provider in Evans, Colorado, licensed in Colorado (CSW.09930278) and active in the NPI registry since December 2018. She is enrolled in Medicare PECOS and is a graduate of Other (2018).

NPPES Registry Identity

NPI1114499811
Entity TypeIndividualFemale
Primary Taxonomy1041C0700X
Provider Legal NameMR. KELLAN JACE STACKCredential: LCSW
Location Address2441 SHOOTING STAR WAYEvans, CO 80620-9243
Mailing Address2441 Shooting Star WayEvans, CO 80620-9243 · (970) 689-6388
Phone(970) 689-6388
Sole ProprietorNo
Medical School CMSOtherGraduated 2018
Enumeration DateDecember 19, 2018
Last NPPES UpdateJuly 1, 20252 updates tracked since enumeration
NPPES CertifiedJuly 1, 2025
✔ NPI 1114499811 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in CO · CSW.09930278
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
2441 SHOOTING STAR WAY, Evans, CO 80620
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Other Names 1

Former Name (1)Ms. Alycia Ann Stack Lcsw

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Providence Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Kellan Jace Stack Lcsw is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID3173006434
PECOS Enrollment IDI20260313004222
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 80620 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$0.00 typical visit price
range $58.06 – $174.82
Typical copayment $0.00 (range $14.51 – $43.70)
Most-billed visit code NA
Established Patient
$72.20 typical visit price
range $18.88 – $142.79
Typical copayment $18.05 (range $4.72 – $35.69)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SPECTRUM THERAPY, PLLC
Social Worker (Clinical)
2441 SHOOTING STAR WAY
EVANS, CO 80620
Weld County (970) 236-1798

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kellan Stack's NPI number?

The NPI number for Kellan Stack is 1114499811. It was assigned to this individual provider in the NPPES registry on December 19, 2018. The provider is also known as Ms. Alycia Ann Stack Lcsw.

Where is Kellan Stack located?

Kellan Stack practices at 2441 Shooting Star Way, Evans, CO 80620. The listed phone number is (970) 689-6388.

What is Kellan Stack's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

Is Kellan Stack enrolled in Medicare?

Yes. Kellan Stack is registered in the Medicare PECOS enrollment system.

What insurance does Kellan Stack accept?

Health plans from Providence Health Plan list Kellan Stack as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kellan Stack was last updated on July 1, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.