Provider Demographics
NPI:1134367097
Name:SKRZYPCHAK, KELLY L (LMSW, CAADC)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:L
Last Name:SKRZYPCHAK
Suffix:
Gender:F
Credentials:LMSW, CAADC
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:L
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:311 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:GRAND LEDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48837-1577
Mailing Address - Country:US
Mailing Address - Phone:517-338-3090
Mailing Address - Fax:
Practice Address - Street 1:311 HARRISON ST
Practice Address - Street 2:
Practice Address - City:GRAND LEDGE
Practice Address - State:MI
Practice Address - Zip Code:48837-1577
Practice Address - Country:US
Practice Address - Phone:173-383-3090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-30
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010904181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical