Provider Demographics
NPI:1184380347
Name:KLEIN, KASEY LYNN (LLMSW)
Entity type:Individual
Prefix:MS
First Name:KASEY
Middle Name:LYNN
Last Name:KLEIN
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:KELSEA
Other - Middle Name:LYNN
Other - Last Name:COLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:235 GOLD AVE NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-5655
Mailing Address - Country:US
Mailing Address - Phone:231-631-3113
Mailing Address - Fax:
Practice Address - Street 1:1959 THORNAPPLE RIVER DR SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-9706
Practice Address - Country:US
Practice Address - Phone:616-327-2405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
MI68511182251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician