Healthcare Provider Details

I. General information

NPI: 1497369946
Provider Name (Legal Business Name): KELLY ALAINE MALSKI LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2020
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 KALAMAZOO AVE SE
GRAND RAPIDS MI
49508-3605
US

IV. Provider business mailing address

4150 KALAMAZOO AVE SE
GRAND RAPIDS MI
49508-3605
US

V. Phone/Fax

Practice location:
  • Phone: 616-913-2034
  • Fax: 616-913-2037
Mailing address:
  • Phone: 616-913-2034
  • Fax: 616-913-2037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801096398
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: