Provider Demographics
NPI:1073763710
Name:SCHIPPER, KYLENE LYNN (LLP)
Entity type:Individual
Prefix:MS
First Name:KYLENE
Middle Name:LYNN
Last Name:SCHIPPER
Suffix:
Gender:
Credentials:LLP
Other - Prefix:MS
Other - First Name:KYLENE
Other - Middle Name:L
Other - Last Name:SCHIPPER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:2040 RAYBROOK ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7718
Mailing Address - Country:US
Mailing Address - Phone:616-402-2133
Mailing Address - Fax:
Practice Address - Street 1:2040 RAYBROOK ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7718
Practice Address - Country:US
Practice Address - Phone:616-402-2133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361001466103TC0700X, 103TC1900X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling