Provider Demographics
NPI:1801139134
Name:SAVAGE, KELLY JEAN (MS, LLP, PSYS)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JEAN
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:MS, LLP, PSYS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51365
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48151-5365
Mailing Address - Country:US
Mailing Address - Phone:586-871-8876
Mailing Address - Fax:
Practice Address - Street 1:42180 FORD RD STE 305
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-3677
Practice Address - Country:US
Practice Address - Phone:586-871-8876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-04
Last Update Date:2024-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361006739103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation