Healthcare Provider Details

I. General information

NPI: 1104431022
Provider Name (Legal Business Name): KAISEY FOLTZ MA, LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1590 10TH ST
MARTIN MI
49070-9728
US

IV. Provider business mailing address

1590 10TH ST
MARTIN MI
49070-9728
US

V. Phone/Fax

Practice location:
  • Phone: 269-685-6363
  • Fax: 269-685-5995
Mailing address:
  • Phone: 269-685-6363
  • Fax: 269-685-5995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6361007745
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: