Healthcare Provider Details

I. General information

NPI: 1851048060
Provider Name (Legal Business Name): KELLIE CROWELL BOWEN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

794 PINE ST STE 230-T
MUSKEGON MI
49442-1020
US

IV. Provider business mailing address

964 W LAKETON AVE
MUSKEGON MI
49441-2967
US

V. Phone/Fax

Practice location:
  • Phone: 616-295-8284
  • Fax: 616-834-0446
Mailing address:
  • Phone: 231-286-0904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801121799
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: