Healthcare Provider Details

I. General information

NPI: 1306752167
Provider Name (Legal Business Name): KAELYN KAUL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 SASHABAW RD
CLARKSTON MI
48346-3156
US

IV. Provider business mailing address

6389 CLARKSTON RD
CLARKSTON MI
48346-1613
US

V. Phone/Fax

Practice location:
  • Phone: 248-623-3900
  • Fax:
Mailing address:
  • Phone: 248-623-5400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: