Provider Demographics
NPI:1528768900
Name:DEAN, KELSEY (LM CPM)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:
Last Name:DEAN
Suffix:
Gender:F
Credentials:LM CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24418 GREYDALE ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-2829
Mailing Address - Country:US
Mailing Address - Phone:586-468-3375
Mailing Address - Fax:
Practice Address - Street 1:24418 GREYDALE ST
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48036-2829
Practice Address - Country:US
Practice Address - Phone:586-468-3375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7601000111176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7601000111OtherSTATE MIDWIFERY LICENSE
CPM22100123OtherNORTH AMERICAN REGISTRY OF MIDWIVES