Healthcare Provider Details

I. General information

NPI: 1821889981
Provider Name (Legal Business Name): KEYLAIHA BROWN LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2025
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2172 DEAN LAKE AVE NE
GRAND RAPIDS MI
49505-4444
US

IV. Provider business mailing address

642 36TH ST SW APT 301
WYOMING MI
49509-5402
US

V. Phone/Fax

Practice location:
  • Phone: 616-451-2021
  • Fax:
Mailing address:
  • Phone: 616-448-6582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851119901
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: