Healthcare Provider Details

I. General information

NPI: 1609742162
Provider Name (Legal Business Name): KELLI HELENE DELISLE LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 JOHNSON ST
ALPENA MI
49707-1434
US

IV. Provider business mailing address

400 JOHNSON ST
ALPENA MI
49707-1434
US

V. Phone/Fax

Practice location:
  • Phone: 989-356-2161
  • Fax: 989-354-5898
Mailing address:
  • Phone: 989-356-2161
  • Fax: 989-354-5898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851119656
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: