Healthcare Provider Details

I. General information

NPI: 1366230682
Provider Name (Legal Business Name): KAYSE GESELLE HERRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39453 FORD RD
CANTON MI
48187-4320
US

IV. Provider business mailing address

39453 FORD RD
CANTON MI
48187-4320
US

V. Phone/Fax

Practice location:
  • Phone: 248-277-3005
  • Fax:
Mailing address:
  • Phone: 248-277-3005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101009916
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: