Active NPI
Jeffrey Kieliszewski, PHD
- Psychologist
- Grand Rapids, MI
National Provider Identifier
1285670570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- JK010594
- Practice address
- 161 Ottawa Ave NW
Suite 300C
Grand Rapids, MI 49503-2701 - Phone
- (616) 458-0692
- Fax
- (616) 458-8129
- NPI assigned
- Jun 22, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | JK010594 | MI | Primary |
Addresses
Primary practice location
161 Ottawa Ave NW
Suite 300C
Grand Rapids, MI 49503-2701
Mailing address
161 Ottawa Ave NW
Suite 300C
Grand Rapids, MI 49503-2701
Phone (616) 458-0692
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| JK010594 | MI | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hra Psychological Services PC | Psychologist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1285670570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "161 OTTAWA AVE NW",
"address_2": "SUITE 300C",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495032701",
"telephone_number": "616-458-0692",
"fax_number": "616-458-8129"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "161 OTTAWA AVE NW",
"address_2": "SUITE 300C",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495032701",
"telephone_number": "616-458-0692",
"fax_number": "616-458-8129"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIELISZEWSKI",
"first_name": "JEFFREY",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "JK010594",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.