Healthcare Provider Details

I. General information

NPI: 1861962672
Provider Name (Legal Business Name): KAITLIN PAXTON WARD PHD, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLIN MICHELLE PAXTON

II. Dates (important events)

Enumeration Date: 12/05/2018
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1785 W STADIUM BLVD STE 203C
ANN ARBOR MI
48103-5291
US

IV. Provider business mailing address

1785 W STADIUM BLVD STE 203C
ANN ARBOR MI
48103-5291
US

V. Phone/Fax

Practice location:
  • Phone: 734-913-1093
  • Fax:
Mailing address:
  • Phone: 734-913-1093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801103585
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: