Provider Demographics
NPI:1841943164
Name:KIRK, KELSEY LYNN (MS)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:LYNN
Last Name:KIRK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4803 GLORIA ST
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-2265
Mailing Address - Country:US
Mailing Address - Phone:810-691-8096
Mailing Address - Fax:
Practice Address - Street 1:5340 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-9341
Practice Address - Country:US
Practice Address - Phone:734-462-3210
Practice Address - Fax:734-369-6084
Is Sole Proprietor?:No
Enumeration Date:2022-01-27
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361007970103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist