Provider Demographics
NPI:1093288060
Name:MAAS, KELSEY (BS)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:MAAS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:KELSEY
Other - Middle Name:
Other - Last Name:ENSING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2172 DEAN LAKE AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49505-4444
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:616-284-5863
Practice Address - Street 1:2172 DEAN LAKE AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49505-4444
Practice Address - Country:US
Practice Address - Phone:616-540-9663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI106S0000XMedicaid