Healthcare Provider Details

I. General information

NPI: 1073196200
Provider Name (Legal Business Name): KAYLA EMELY ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 VISTA DR
COLDWATER MI
49036-1776
US

IV. Provider business mailing address

357 S MATTESON ST
BRONSON MI
49028-1512
US

V. Phone/Fax

Practice location:
  • Phone: 517-278-2129
  • Fax:
Mailing address:
  • Phone: 517-617-5151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801116491
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: