Healthcare Provider Details

I. General information

NPI: 1750267209
Provider Name (Legal Business Name): KERRI CHAMBERLAIN LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 GRAND RIDGE CT NE STE 200
GRAND RAPIDS MI
49525-7043
US

IV. Provider business mailing address

3993 WEDGEWOOD DR SW
WYOMING MI
49519-3137
US

V. Phone/Fax

Practice location:
  • Phone: 616-426-9034
  • Fax:
Mailing address:
  • Phone: 616-836-4515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851103082
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: