Provider Demographics
NPI:1114653706
Name:ANDERSON, KAILYN GRACE (LLBSW)
Entity Type:Individual
Prefix:
First Name:KAILYN
Middle Name:GRACE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 40TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-6084
Mailing Address - Country:US
Mailing Address - Phone:616-241-6258
Mailing Address - Fax:616-827-4359
Practice Address - Street 1:1111 40TH ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-6084
Practice Address - Country:US
Practice Address - Phone:616-241-6258
Practice Address - Fax:616-827-4359
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker