Healthcare Provider Details

I. General information

NPI: 1063332500
Provider Name (Legal Business Name): KELLY BAUSE LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 WATKINS BLVD
HIGHLAND MI
48357-4980
US

IV. Provider business mailing address

2368 S MILFORD RD
HIGHLAND MI
48357-4934
US

V. Phone/Fax

Practice location:
  • Phone: 248-684-8190
  • Fax:
Mailing address:
  • Phone: 248-684-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number6851118760
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: