Healthcare Provider Details

I. General information

NPI: 1942893870
Provider Name (Legal Business Name): KATELIN ZYLKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 12/28/2022
Certification Date: 10/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39325 PLYMOUTH RD STE 202
LIVONIA MI
48150-4531
US

IV. Provider business mailing address

16918 COMSTOCK ST
LIVONIA MI
48154-1608
US

V. Phone/Fax

Practice location:
  • Phone: 248-892-9497
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801114831
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: