Healthcare Provider Details

I. General information

NPI: 1164309209
Provider Name (Legal Business Name): KASEY NICOLE BRYANT MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 PACKARD ST
ANN ARBOR MI
48108-2073
US

IV. Provider business mailing address

2041 ARBOR CIR W APT 104
YPSILANTI MI
48197-3411
US

V. Phone/Fax

Practice location:
  • Phone: 734-845-5058
  • Fax:
Mailing address:
  • Phone: 517-894-8363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number106987
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: