Provider Demographics
NPI:1982308185
Name:SANNER, KELLI JEAN (LLBSW)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:JEAN
Last Name:SANNER
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:JEAN
Other - Last Name:ROTTSCHAFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:483 CENTURY LN
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4286
Mailing Address - Country:US
Mailing Address - Phone:616-396-5284
Mailing Address - Fax:616-396-8387
Practice Address - Street 1:483 CENTURY LN
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-4286
Practice Address - Country:US
Practice Address - Phone:616-396-5284
Practice Address - Fax:616-396-8387
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6852093659104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker