Provider Demographics
NPI:1184367054
Name:TILLOTTSON, KARLEENA ANN (LMSW)
Entity type:Individual
Prefix:MS
First Name:KARLEENA
Middle Name:ANN
Last Name:TILLOTTSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:KARLEENA
Other - Middle Name:ANN
Other - Last Name:TILLOTTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 68TH ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-6927
Mailing Address - Country:US
Mailing Address - Phone:616-258-7467
Mailing Address - Fax:616-258-7432
Practice Address - Street 1:926 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-7725
Practice Address - Country:US
Practice Address - Phone:616-820-3780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011166621041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical