Healthcare Provider Details

I. General information

NPI: 1578489738
Provider Name (Legal Business Name): KELTIE PALMER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 NORTHLAND DR NE STE 1
ROCKFORD MI
49341-1401
US

IV. Provider business mailing address

PO BOX 384
ROCKFORD MI
49341-0384
US

V. Phone/Fax

Practice location:
  • Phone: 616-232-6612
  • Fax:
Mailing address:
  • Phone: 616-232-6612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401225616
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: