Healthcare Provider Details

I. General information

NPI: 1780244673
Provider Name (Legal Business Name): KATLYNN ELIZABETH BOVEE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 KENMOOR AVE SE STE 113487
GRAND RAPIDS MI
49546-2395
US

IV. Provider business mailing address

625 KENMOOR AVE SE STE 113487
GRAND RAPIDS MI
49546-2395
US

V. Phone/Fax

Practice location:
  • Phone: 989-225-7652
  • Fax: 989-391-9596
Mailing address:
  • Phone: 989-225-7652
  • Fax: 989-391-9596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: