Healthcare Provider Details

I. General information

NPI: 1932089877
Provider Name (Legal Business Name): KAITLIN BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 R DALE WERTZ DR
BAD AXE MI
48413-1365
US

IV. Provider business mailing address

1375 R DALE WERTZ DR
BAD AXE MI
48413-1365
US

V. Phone/Fax

Practice location:
  • Phone: 989-269-9293
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851120643
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: