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NPI Code Detail

MEDICARE: JENNIFER KIDA

MEDICARE: JENNIFER KIDA
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
1103T00000XPsychologist6362010099MI

General Provider Information

NPI Number : 1932855483
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER KIDA
Provider Business Mailing Address
First Line : 3111 ELECTRIC AVE
Second Line :
City : PORT HURON
State : MI
Zip : 48060-8127
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3111 ELECTRIC AVE
Second Line :
City : PORT HURON
State : MI
Zip : 48060-8127
Country : US
Telephone Number : 810-985-8900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2022
Last Update Date : 06/17/2026

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Directions to “ JENNIFER KIDA ” Practice Location

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