Healthcare Provider Details

I. General information

NPI: 1629460191
Provider Name (Legal Business Name): KELSEY WRIGHT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KELSEY MACKENZIE LLMSW

II. Dates (important events)

Enumeration Date: 02/20/2015
Last Update Date: 02/02/2022
Certification Date: 02/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 N EVERGREEN DR NE
GRAND RAPIDS MI
49525-9334
US

IV. Provider business mailing address

790 FULLER AVE NE
GRAND RAPIDS MI
49503-1918
US

V. Phone/Fax

Practice location:
  • Phone: 616-364-1500
  • Fax:
Mailing address:
  • Phone: 616-336-3909
  • Fax: 616-336-8830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801095834
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: