Individual provider Active NPI

Kelsey Wright, LMSW

  • Clinical Social Worker
  • Grand Rapids, MI
National Provider Identifier
1629460191
Registry record updated Feb 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
6801095834 Issued in MI
Practice address
3225 N Evergreen Dr NE
Grand Rapids, MI 49525-9334
Phone
(616) 364-1500
NPI assigned
Feb 20, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 2, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6801095834 MI Primary

Addresses

Primary practice location

3225 N Evergreen Dr NE
Grand Rapids, MI 49525-9334

Mailing address

790 Fuller Ave NE
Grand Rapids, MI 49503-1918
Phone (616) 336-3909

Other practice location 1

805 Leonard St NE
Grand Rapids, MI 49503-1138
Phone (616) 451-2021

Other practice location 2

790 Fuller Ave NE
Grand Rapids, MI 49503-1918
Phone (616) 336-3909

Other names 1

  • Mrs. Kelsey Mackenzie Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pcerecords.network180.x@direct.mihin.net Direct

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
6801095834MIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
D.a. Blodgett - St. John'S Past Accepting new patients
D a Blodgett-St Johns Clinical PastSince Oct 10, 2015 Accepting new patients

Organizations & group practices 2

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": "1424390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643760000000",
    "number": "1629460191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 FULLER AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495031918",
            "telephone_number": "616-336-3909",
            "fax_number": "616-336-8830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3225 N EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259334",
            "telephone_number": "616-364-1500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "805 Leonard St NE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495031138",
            "country_code": "US",
            "telephone_number": "616-451-2021",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "790 Fuller Ave NE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495031918",
            "country_code": "US",
            "telephone_number": "616-336-3909",
            "fax_number": "616-336-8830",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WRIGHT",
        "first_name": "KELSEY",
        "name_prefix": "Mrs.",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-02-20",
        "last_updated": "2022-02-02",
        "certification_date": "2022-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801095834",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pcerecords.network180.x@direct.mihin.net",
            "affiliation": "N",
            "endpointDescription": "Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "790 Fuller Ave NE",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495031918",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KELSEY",
            "last_name": "MACKENZIE",
            "prefix": "MRS.",
            "credential": "LLMSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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 Feb 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.