Healthcare Provider Details

I. General information

NPI: 1487136529
Provider Name (Legal Business Name): KAYLA GRZECH LMSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2018
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 GRISWOLD ST SE
GRAND RAPIDS MI
49507-3814
US

IV. Provider business mailing address

1215 GRISWOLD ST SE
GRAND RAPIDS MI
49507-3814
US

V. Phone/Fax

Practice location:
  • Phone: 616-987-4683
  • Fax: 828-340-1177
Mailing address:
  • Phone: 616-987-4683
  • Fax: 828-340-1177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC013728
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801115897
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: