Healthcare Provider Details

I. General information

NPI: 1982443909
Provider Name (Legal Business Name): KELSEY PLENCNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 EDITH AVE NE
GRAND RAPIDS MI
49505-5505
US

IV. Provider business mailing address

1125 EDITH AVE NE
GRAND RAPIDS MI
49505-5505
US

V. Phone/Fax

Practice location:
  • Phone: 616-459-7215
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6451023600APP24
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: