MEDICARE: KELLY POWERS GUTIERREZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801107437	MI

General Provider Information

NPI Number	:	1457967598
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY POWERS GUTIERREZ

Provider Business Mailing Address
First Line	:	2016 GODWIN AVE SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49507-3126
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	967 SPAULDING AVE SE STE E
Second Line	:
City	:	ADA
State	:	MI
Zip	:	49301-3703
Country	:	US
Telephone Number	:	616-965-1298
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2020
Last Update Date	:	05/17/2026

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Directions to “ KELLY POWERS GUTIERREZ ” Practice Location

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