Healthcare Provider Details

I. General information

NPI: 1730092719
Provider Name (Legal Business Name): MIKENNA BAYLESS LLMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 E OHIO ST
MARQUETTE MI
49855-3847
US

IV. Provider business mailing address

2942 CEDARVILLE DR APT 2
MARQUETTE MI
49855-8661
US

V. Phone/Fax

Practice location:
  • Phone: 906-226-5161
  • Fax: 906-226-5134
Mailing address:
  • Phone: 906-226-5100
  • Fax: 906-226-5134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851120263
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: