Healthcare Provider Details

I. General information

NPI: 1831981273
Provider Name (Legal Business Name): KAYLEE JOHNSON LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 PLAINFIELD AVE NE STE A
GRAND RAPIDS MI
49525-1010
US

IV. Provider business mailing address

5242 PLAINFIELD AVE NE STE F
GRAND RAPIDS MI
49525-1084
US

V. Phone/Fax

Practice location:
  • Phone: 616-613-6036
  • Fax:
Mailing address:
  • Phone: 616-612-6036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851119528
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: