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NPI Code Detail

MEDICARE: KAILYN MCKINSEY RANGUETTE TLLP

MEDICARE: KAILYN MCKINSEY RANGUETTE TLLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC1900XCounseling Psychologist
2103TC1900XCounseling Psychologist6362009536MI

General Provider Information

NPI Number : 1346969557
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAILYN MCKINSEY RANGUETTE TLLP
Provider Business Mailing Address
First Line : 4690 FULTON ST E STE 102
Second Line :
City : ADA
State : MI
Zip : 49301-8454
Country : US
Telephone Number : 616-425-7701
Fax Number :
Provider Business Practice Location Address
First Line : 4690 FULTON ST E STE 102
Second Line :
City : ADA
State : MI
Zip : 49301-8454
Country : US
Telephone Number : 616-425-7701
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2022
Last Update Date : 06/14/2024

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Directions to “ KAILYN MCKINSEY RANGUETTE TLLP” Practice Location

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