Provider Demographics
NPI:1063701175
Name:BOEVE, KELLY JO (LLP)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:JO
Last Name:BOEVE
Suffix:
Gender:F
Credentials:LLP
Other - Prefix:MS
Other - First Name:KELLY
Other - Middle Name:JO
Other - Last Name:VAN VALKENBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLP
Mailing Address - Street 1:12265 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49424-8613
Mailing Address - Country:US
Mailing Address - Phone:616-393-5698
Mailing Address - Fax:616-393-5687
Practice Address - Street 1:12265 JAMES ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49424-8613
Practice Address - Country:US
Practice Address - Phone:616-393-5698
Practice Address - Fax:616-393-5687
Is Sole Proprietor?:No
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011390103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities