Healthcare Provider Details

I. General information

NPI: 1871159194
Provider Name (Legal Business Name): KELLI SUSAN POSTEMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLI POSTEMA; SWANDER

II. Dates (important events)

Enumeration Date: 05/13/2019
Last Update Date: 07/28/2022
Certification Date: 07/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3124 N WELLNESS DR STE 50
HOLLAND MI
49424-8121
US

IV. Provider business mailing address

3124 N WELLNESS DR STE 50
HOLLAND MI
49424-8121
US

V. Phone/Fax

Practice location:
  • Phone: 616-247-3815
  • Fax:
Mailing address:
  • Phone: 616-558-0801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801110720
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: