Provider Demographics
NPI:1508414368
Name:BADER, KYLIE MARIE (LLMSW)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:MARIE
Last Name:BADER
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:MARIE
Other - Last Name:DEKRYGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 CRESCENT ST
Mailing Address - Street 2:
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-1412
Mailing Address - Country:US
Mailing Address - Phone:269-312-2007
Mailing Address - Fax:269-375-4362
Practice Address - Street 1:1090 N 10TH ST STE 110
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-5733
Practice Address - Country:US
Practice Address - Phone:269-375-4363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-26
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011044481041C0700X
MI68011099831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical