Provider Demographics
NPI:1346968138
Name:ARRENDONDO, KELLI V (LMSW)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:V
Last Name:ARRENDONDO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 E BRIDGE ST STE C-2
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-1350
Mailing Address - Country:US
Mailing Address - Phone:616-447-0177
Mailing Address - Fax:
Practice Address - Street 1:8 E BRIDGE ST STE C-2
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-1350
Practice Address - Country:US
Practice Address - Phone:616-600-2845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801085833104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty