Provider Demographics
NPI:1598195992
Name:WILKINSON, KELLI (LMSW)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:RAE
Other - Last Name:MACIAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:135 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-5845
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:135 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-5845
Practice Address - Country:US
Practice Address - Phone:989-895-2322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-21
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010883981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical