Healthcare Provider Details

I. General information

NPI: 1902737885
Provider Name (Legal Business Name): KIDOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 N CANTON
CANTON MI
48187
US

IV. Provider business mailing address

5820 N CANTON
CANTON MI
48187
US

V. Phone/Fax

Practice location:
  • Phone: 734-987-4875
  • Fax: 734-328-1161
Mailing address:
  • Phone: 734-987-4875
  • Fax: 734-328-1161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MANAL CHEHADEH
Title or Position: ORGANIZER
Credential:
Phone: 734-987-4875