Healthcare Provider Details

I. General information

NPI: 1043734783
Provider Name (Legal Business Name): KELLY LYNN O'BRIEN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13560 DAVISBURG RD
DAVISBURG MI
48350-2314
US

IV. Provider business mailing address

13560 DAVISBURG RD
DAVISBURG MI
48350-2314
US

V. Phone/Fax

Practice location:
  • Phone: 248-222-4048
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801105544
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: