Healthcare Provider Details

I. General information

NPI: 1295470474
Provider Name (Legal Business Name): KIDOLOGY INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 N CANTON CENTER RD STE 180
CANTON MI
48187-2680
US

IV. Provider business mailing address

5820 N CANTON CENTER RD STE 180
CANTON MI
48187-2680
US

V. Phone/Fax

Practice location:
  • Phone: 248-800-2928
  • Fax: 248-800-7272
Mailing address:
  • Phone: 734-987-4875
  • Fax: 734-328-1161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: DR. NAME NAME
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 734-987-4875