Healthcare Provider Details

I. General information

NPI: 1639007354
Provider Name (Legal Business Name): KAYLEE HARRISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4305 S CEDAR ST
LANSING MI
48910-5461
US

IV. Provider business mailing address

1054 CLIFFDALE DR
HASLETT MI
48840-9781
US

V. Phone/Fax

Practice location:
  • Phone: 517-887-2762
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851121746
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: