Provider Demographics
NPI:1912293143
Name:HEIKKURI, KELLY (LBSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:HEIKKURI
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANN
Other - Last Name:HUNDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1434
Mailing Address - Country:US
Mailing Address - Phone:989-356-2161
Mailing Address - Fax:
Practice Address - Street 1:400 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1434
Practice Address - Country:US
Practice Address - Phone:989-356-2161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-27
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802086997104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker