Provider Demographics
NPI:1073763710
Name:SCHIPPER, KYLENE LYNN (LLP)
Entity Type:Individual
Prefix:MS
First Name:KYLENE
Middle Name:LYNN
Last Name:SCHIPPER
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:MS
Other - First Name:KYLENE
Other - Middle Name:L
Other - Last Name:SCHIPPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:3300 36TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49518-0007
Mailing Address - Country:US
Mailing Address - Phone:616-402-2133
Mailing Address - Fax:
Practice Address - Street 1:3300 36TH ST
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49518-0007
Practice Address - Country:US
Practice Address - Phone:616-402-2133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014008103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling