Healthcare Provider Details

I. General information

NPI: 1316348634
Provider Name (Legal Business Name): KAYLA KEANE MERRILL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 ROBINSON RD SE
GRAND RAPIDS MI
49506-1745
US

IV. Provider business mailing address

1500 ROBINSON RD SE
GRAND RAPIDS MI
49506-1745
US

V. Phone/Fax

Practice location:
  • Phone: 616-318-2730
  • Fax:
Mailing address:
  • Phone: 616-318-2730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801109339
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: