Kathleen Piccoli, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6301019499 Issued in MI

Practice address

235 Wealthy St SE
Grand Rapids, MI 49503-5247

Phone

(616) 840-8668

Fax

(616) 840-9762

NPI assigned

Aug 3, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mary Free Bed Rehabilitation HospitalGroup PAC ID 4587576541, 135 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mary Free Bed Rehabilitation Hospital Inpatient rehabilitation facility, Grand Rapids, MI, CCN 233026

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Mary Free Bed Rehabilitation Hospital

  • Rehabilitation Hospital
  • Grand Rapids, MI
  • NPI 1730133463
  Medicare reassignment Care Compare group NPD
• Mary Free Bed Rehabiltation Hospital

  • Physical Medicine & Rehabilitation Physician
  • Grand Rapids, MI
  • NPI 1932372919
  NPD
• Mary Free Bed Rehabilitation Hospital

  • Physical Medicine & Rehabilitation Physician
  • Grand Rapids, MI
  • NPI 1053641589
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mary Free Bed Rehabilitation Hospital

  • Rehabilitation Hospital
  • Grand Rapids, MI
  • NPI 1730133463

  Inpatient rehabilitation facility

  Care Compare affiliation

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

{
    "created_epoch": "1627948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738540800000",
    "number": "1871267930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 WEALTHY ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495035247",
            "telephone_number": "616-840-8668",
            "fax_number": "616-840-9762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 WEALTHY ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495035247",
            "telephone_number": "616-840-8668",
            "fax_number": "616-840-9762"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1550 3 Mile Rd NW Ste C",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495448251",
            "country_code": "US",
            "telephone_number": "616-840-8807",
            "fax_number": "616-840-9684",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PICCOLI",
        "first_name": "KATHLEEN",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-03",
        "last_updated": "2025-02-03",
        "certification_date": "2025-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CO",
            "license": "0006030",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301019499",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301019499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kpiccoli165807@direct.covenanthealthcare.com",
            "affiliation": "N",
            "address_1": "1550 3 Mile Rd NW Ste C",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495448251",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kpiccoli165807@direct.covenanthealthcare.com",
            "affiliation": "N",
            "address_1": "235 Wealthy St SE",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495035247",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Emily Autumn Pianko, RD
• Katelyn Piascik
• Emma Piasecki, PA
• Marella Piazza
• Rebecca Piccard, LMSW
• Joshua Pickel
• Christian Pickens
• Robert Pickett
• Sherry Pickett
• Jesse J Piehl, PHD

• Psychologist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.