Healthcare Provider Details

I. General information

NPI: 1609143569
Provider Name (Legal Business Name): DEVIN A GILL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEVIN A KENNEDY LMSW

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5705 W JOHNSON RD
LUDINGTON MI
49431-1516
US

IV. Provider business mailing address

5705 W JOHNSON RD
LUDINGTON MI
49431-1516
US

V. Phone/Fax

Practice location:
  • Phone: 231-425-4414
  • Fax: 231-425-4434
Mailing address:
  • Phone: 231-425-4414
  • Fax: 231-425-4434

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704404207
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801092134
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: