Kellie Vincent, LLMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6851110285 Issued in MI

Practice address

5340 Plymouth Rd Ste 104
Ann Arbor, MI 48105-9557

Phone

(765) 541-8635

NPI assigned

Oct 3, 2022

Last updated

Oct 3, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Kellie Devaughn Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1664755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664755200000",
    "number": "1730803883",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29314 MEADOWLARK ST",
            "city": "LIVONIA",
            "state": "MI",
            "postal_code": "481544580",
            "telephone_number": "765-541-8635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5340 PLYMOUTH RD STE 104",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481059557",
            "telephone_number": "765-541-8635"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VINCENT",
        "first_name": "KELLIE",
        "name_prefix": "Mrs.",
        "credential": "LLMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-10-03",
        "last_updated": "2022-10-03",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6851110285",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLIE",
            "last_name": "DEVAUGHN",
            "credential": "LLMSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mirko Villanueva, MD
• Roy Villareal, PARAMEDIC
• Rowena Jane Villarias, CNM
• Sally Villasenor, NP
• Fletcher Gregory Vilt, MD
• Lisa M Vincent, LPC
• Andrew K Vine, MD
• Christina Violante, DC
• Suhana Maria Virdee
• Timothy Patrick Visclosky, MD

• Clinical Social Worker in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 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.