Healthcare Provider Details

I. General information

NPI: 1619531597
Provider Name (Legal Business Name): CASSIDY KUCZAJDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2019
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date: 06/19/2023
Reactivation Date: 03/19/2024

III. Provider practice location address

724 E SUPERIOR ST
ALMA MI
48801-1900
US

IV. Provider business mailing address

2521 N ELMS RD
FLUSHING MI
48433-9423
US

V. Phone/Fax

Practice location:
  • Phone: 810-487-5521
  • Fax:
Mailing address:
  • Phone: 810-487-5521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: