Provider Demographics
NPI:1942942420
Name:LAVASSEUR, KATLYN ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:ANNE
Last Name:LAVASSEUR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 W BLUFFS DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7107
Mailing Address - Country:US
Mailing Address - Phone:734-272-7093
Mailing Address - Fax:
Practice Address - Street 1:2730 5 MILE RD NE STE 101
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-6518
Practice Address - Country:US
Practice Address - Phone:616-426-9401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011020581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical