Healthcare Provider Details

I. General information

NPI: 1073117941
Provider Name (Legal Business Name): KELLY M TAUSCHEK-HILL LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1519 N MAIN ST STE C
THREE RIVERS MI
49093-1377
US

IV. Provider business mailing address

1519 N MAIN ST STE C
THREE RIVERS MI
49093-1377
US

V. Phone/Fax

Practice location:
  • Phone: 269-273-2024
  • Fax: 269-273-3191
Mailing address:
  • Phone: 269-273-2024
  • Fax: 269-273-3191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801100908
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801113635
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: