Healthcare Provider Details

I. General information

NPI: 1902731458
Provider Name (Legal Business Name): KAITLYNN BECKER LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 DELHI COMMERCE DR STE 5
HOLT MI
48842-2193
US

IV. Provider business mailing address

7204 E GRAND RIVER AVE LOT 390
PORTLAND MI
48875-8830
US

V. Phone/Fax

Practice location:
  • Phone: 517-258-0083
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851120650
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: