MEDICARE: KELLEY CLIMIE LLMSW

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	6801104891	MI

General Provider Information

NPI Number	:	1841931375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY CLIMIE LLMSW

Provider Business Mailing Address
First Line	:	72 NORTH AVE
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49017-3415
Country	:	US
Telephone Number	:	616-288-4908
Fax Number	:	855-320-3424

Provider Business Practice Location Address
First Line	:	72 NORTH AVE
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49017-3415
Country	:	US
Telephone Number	:	616-288-4908
Fax Number	:	855-320-3424

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

Provider Enumeration Date	:	04/06/2022
Last Update Date	:	04/06/2022

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