Healthcare Provider Details

I. General information

NPI: 1245118850
Provider Name (Legal Business Name): KAYLEE JAYDE GLEW LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36661 MAIN ST
NEW BALTIMORE MI
48047-2552
US

IV. Provider business mailing address

4200 CHADBURNE DR
LANSING MI
48911-2576
US

V. Phone/Fax

Practice location:
  • Phone: 586-675-8424
  • Fax: 586-500-5660
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801120411
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: