MEDICARE: KAITLYN MARIE HEUER LMSW

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
1	1041C0700X	Clinical Social Worker	6801104769	MI

General Provider Information

NPI Number	:	1962003780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN MARIE HEUER LMSW

Provider Business Mailing Address
First Line	:	23614 MARLBOROUGH DR
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48036-1221
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	51539 VAN DYKE AVE
Second Line	:
City	:	SHELBY TWP
State	:	MI
Zip	:	48316-4447
Country	:	US
Telephone Number	:	586-461-2111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2020
Last Update Date	:	11/06/2020

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