Healthcare Provider Details

I. General information

NPI: 1962340802
Provider Name (Legal Business Name): KERRI LYNN MORGAN GIRTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KERRI LYNN MORGAN BLAIR

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3361 36TH ST SE
KENTWOOD MI
49512-2809
US

IV. Provider business mailing address

3361 36TH ST SE
KENTWOOD MI
49512-2809
US

V. Phone/Fax

Practice location:
  • Phone: 616-558-5021
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: