Healthcare Provider Details

I. General information

NPI: 1699364497
Provider Name (Legal Business Name): ROWAN KELLEY MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E 3RD ST
BUCHANAN MI
49107-1404
US

IV. Provider business mailing address

500 E 3RD ST
BUCHANAN MI
49107-1404
US

V. Phone/Fax

Practice location:
  • Phone: 269-224-0977
  • Fax: 269-224-0978
Mailing address:
  • Phone: 269-224-0977
  • Fax: 269-224-0978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401225208
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number39004723A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: