Healthcare Provider Details

I. General information

NPI: 1174368625
Provider Name (Legal Business Name): KALIE SCHMIDT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3637 COLONIAL AVE NE
GRAND RAPIDS MI
49525-2209
US

IV. Provider business mailing address

3637 COLONIAL AVE NE
GRAND RAPIDS MI
49525-2209
US

V. Phone/Fax

Practice location:
  • Phone: 616-914-9195
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: KALIE SCHMIDT
Title or Position: LMSW
Credential:
Phone: 616-914-9195