Rebecca Ann-Pastoor Kelley, LLBSW, QIDP

Primary specialty

Social WorkerTaxonomy code 104100000X

License

68020810 Issued in MI

Practice address

1111 40TH St SE
Grand Rapids, MI 49508-6084

Phone

(616) 241-6258

Fax

(616) 241-6470

NPI assigned

Dec 28, 2017

Last updated

Jul 5, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Spectrum Community Services

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Westland, MI
  • NPI 1164577391
  NPD
• Spectrum Community Services

  • Home Health Agency
  • Westland, MI
  • NPI 1457117962
  NPD

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

{
    "created_epoch": "1514419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720137600000",
    "number": "1902312952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 40TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495086084",
            "telephone_number": "616-241-6258",
            "fax_number": "616-241-6470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 40TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495086084",
            "telephone_number": "616-241-6258",
            "fax_number": "616-241-6470"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3353 Lousma Dr SE",
            "address_purpose": "LOCATION",
            "city": "Wyoming",
            "state": "MI",
            "postal_code": "495482251",
            "country_code": "US",
            "telephone_number": "616-241-6259 x4205",
            "fax_number": "616-241-6470",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KELLEY",
        "first_name": "REBECCA",
        "middle_name": "ANN-PASTOOR",
        "credential": "LLBSW, QIDP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-28",
        "last_updated": "2024-07-05",
        "certification_date": "2024-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "68020810",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine A Kelley, M.D.
• Linda A. Kelley, MA, CCC-SLP
• Lynn Marie Kelley, R.N.
• Mark Donald Kelley, FNP-BC
• Nikkea Kelley, LLMSW,MSW,C-YFSW
• Regan Kelley, OTR/L
• Serena Leigh Kelley
• Jenny Kellogg, LMSW
• Megan Kellogg
• Kelly Ahti, LMSW PLLC

• Social Worker in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2024; 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.