Provider Demographics
NPI:1609505742
Name:DELONG, KELLY SUE (LMSW)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:SUE
Last Name:DELONG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:SUE
Other - Last Name:GEIGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:233 FULTON ST E STE 222
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-3262
Mailing Address - Country:US
Mailing Address - Phone:616-490-3468
Mailing Address - Fax:616-369-1281
Practice Address - Street 1:233 FULTON ST E STE 222
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-3262
Practice Address - Country:US
Practice Address - Phone:616-490-3468
Practice Address - Fax:616-369-1281
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511151811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical