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Kellan Jace Stack , LCSW

Social Worker - Clinical β€’ Evans, CO

Active NPI 1114499811 Individual Practitioner Female Practitioner
Practice location in NPPES

2441 Shooting Star Way
Evans, CO 806209243

Call 9706896388 Location details and other listings
Medical Disclaimer

This profile restates public CMS/NPPES data; T-MedInfo gives no medical advice — consult a licensed professional, and call 911 for emergencies.

Practice Location & Contact Primary Location

Practice Address

2441 Shooting Star Way

Evans, CO 806209243

Telephone 9706896388
Organization at the Same NPPES Address or Phone
Spectrum Therapy, Pllc Facility NPI 1912861642

Matched by practice address or phone in NPPES. A shared address or phone does not confirm that this clinician works there.

Medicare Profile & Education

Source: CMS Doctors and Clinicians National Downloadable File

Graduation Year

2018

Years since graduation

8 years (graduated 2018)

CMS Doctors and Clinicians data list 2018 as the year this clinician finished professional school.

What this does not show: Years since graduation

It is not the number of years in practice, and more years does not mean better care.

Source: CMS Doctors and Clinicians National Downloadable File.

NPI first issued

2018

The year this clinician's National Provider Identifier (NPI) was issued. An NPI is a unique 10-digit ID that US health care providers use for billing.

What this does not show: NPI first issued

NPIs have been issued only since 2005, so this year is not necessarily when the clinician started practicing.

Source: CMS NPPES NPI Registry.

May accept Medicare assignment

CMS data show this clinician may accept Medicare assignment. Clinicians who do not always accept assignment can decide case by case.

Medicare assignment applies to Original Medicare. It does not tell you whether the clinician is in a Medicare Advantage plan's network, accepts other insurance, or is taking new patients.

Source: CMS Doctors and Clinicians; Medicare.gov, β€œDoes your provider accept Medicare as full payment?”

Guide: What Medicare assignment means

No telehealth indicator

CMS shows this indicator only when recent Medicare claims include telehealth services. The clinician may still offer telehealth; ask the office.

Source: CMS, Telehealth Indicator on Medicare Care Compare (fact sheet, January 2023); CMS Doctors and Clinicians.

Guide: How Medicare covers telehealth

Enrolled in Medicare (PECOS)

Kellan Stack has a Medicare enrollment record in PECOS, the CMS system clinicians use to enroll so they can bill Medicare or order services for people with Medicare.

It does not show whether the clinician accepts assignment, is in your plan's network, or is taking new patients.

Source: CMS Medicare Fee-For-Service Public Provider Enrollment (PECOS); CMS Order and Referring file.

Guide: What Medicare enrollment (PECOS) means

Can order Medicare-covered services

CMS lists Kellan Stack as eligible to order or refer Medicare Part B clinical laboratory and imaging services and durable medical equipment (DME) for people with Medicare.

What this does not show: Can order Medicare-covered services

It does not mean the clinician offers these services directly.

Source: CMS Medicare Fee-For-Service Public Provider Enrollment (PECOS); CMS Order and Referring file.

Guide: What ordering and referring status means

Compared with the same specialty in Evans and Colorado

6 active clinicians are listed under Social Worker - Clinical with a practice address in Evans, CO (7,364 in Colorado).

Addresses are self-reported to NPPES and may be out of date.

Sources: CMS Doctors and Clinicians, CMS NPPES NPI Registry. Specialty names follow the NUCC Health Care Provider Taxonomy.

Text: T-MedInfo Β· Report an error.

Specialties & License Numbers Reported to NPPES

Self-certified to NPPES: 2025-07-01
Social Worker - Clinical Primary Specialty

NUCC Taxonomy Code: 1041C0700X

License # reported to NPPES CO CSW.09930278

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.

Check License Status with the State Board License numbers are self-reported to NPPES; T-MedInfo does not confirm them against state records. Current status: Colorado Division of Professions and Occupations.
Look Up on State Board Site

Medicare (PECOS) Enrollment & Ordering Eligibility

Source: CMS PECOS
Medicare FFS Enrollment Status Medicare Enrollment on File
CMS Provider Specialty

PRACTITIONER - CLINICAL SOCIAL WORKER

Medicare Enrollment ID

I20260313004222

Enrollment State Jurisdiction

CO

PECOS Control ID

3173006434

Medicare Order & Referring Eligibility
Clinical Lab & Imaging (Part B) Eligible
Durable Medical Equipment (DME) Eligible
Home Health Agency (HHA) Not Eligible
Power Mobility Devices (PMD) Not Eligible

Sources: CMS Provider Enrollment and Order and Referring. Medicare enrollment is a billing status, not an accreditation or quality rating.

Career & Practice History Timeline

Changes recorded in monthly NPPES data files: addresses, names, credentials, specialties and NPI status

11 Historical Events
πŸ‘€
Provider Name / Credentials Updated July 01, 2025

Recorded as KELLAN STACK, LCSW

πŸ“
Updated Practice Location March 22, 2024

Registered at 2441 SHOOTING STAR WAY, EVANS, CO 806209243 (Tel: 9706896388)

πŸ“
Updated Business Mailing Address March 22, 2024

Registered at 2441 SHOOTING STAR WAY, EVANS, CO 806209243 (Tel: 9706896388)

πŸ‘€
Provider Name / Credentials Updated March 22, 2024

Recorded as ALYCIA STACK, LCSW

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) March 22, 2024

Social Worker (license number reported to NPPES: CO CSW.09930278)

βœ…
NPI Profile Active December 19, 2018

NPI status registered as active in NPPES database

πŸ“
Practice Location (Initial Record) December 19, 2018

Registered at 1808 DILMONT AVE, GREELEY, CO 806316207 (Tel: 9706896388)

πŸ“
Business Mailing Address (Initial Record) December 19, 2018

Registered at 1808 DILMONT AVE, GREELEY, CO 806316207 (Tel: 9706896388)

πŸ‘€
Provider Name / Credentials (Initial Record) December 19, 2018

Recorded as ALYCIA ERICKSON, MSW

πŸŽ“
Medical Taxonomy / Specialty Registered (Primary Specialty) December 19, 2018

Counselor

🟒
Initial NPI Registration & Enumeration December 19, 2018

First registered as active Individual Practitioner in NPPES Database.

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NPI Administrative Meta

NPI Number: 1114499811
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: December 19, 2018
Last Update: July 01, 2025
Sole Proprietor: No

Mailing Address

2441 Shooting Star Way

Evans, CO 806209243

Phone: 9706896388

About This Data NPPES fields (address, phone, specialty, license) are self-reported and may be outdated; Medicare fields follow the CMS dataset named in each section. Correct directly at NPPES.