Provider Demographics
NPI:1023307337
Name:BOPRIE, KELLY SUE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:SUE
Last Name:BOPRIE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1115 BALL AVE NE
Mailing Address - Street 2:BUILDING C
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-5904
Mailing Address - Country:US
Mailing Address - Phone:616-459-7215
Mailing Address - Fax:616-451-0020
Practice Address - Street 1:1115 BALL AVE NE
Practice Address - Street 2:BUILDING C
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-5904
Practice Address - Country:US
Practice Address - Phone:616-459-7215
Practice Address - Fax:616-451-0020
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010913261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical