Healthcare Provider Details

I. General information

NPI: 1225714561
Provider Name (Legal Business Name): KADIE GROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 JOLLY OAK RD
OKEMOS MI
48864-3546
US

IV. Provider business mailing address

6549 TOWN CENTER DR
CLARKSTON MI
48346-4824
US

V. Phone/Fax

Practice location:
  • Phone: 800-395-3223
  • Fax: 248-620-6405
Mailing address:
  • Phone: 800-395-3223
  • Fax: 248-620-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: