Healthcare Provider Details

I. General information

NPI: 1831988435
Provider Name (Legal Business Name): KRISTEN ZYLKA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1176 S MAIN ST
PLYMOUTH MI
48170-2252
US

IV. Provider business mailing address

20905 E GLEN HAVEN CIR
NORTHVILLE MI
48167-2466
US

V. Phone/Fax

Practice location:
  • Phone: 734-564-4234
  • Fax:
Mailing address:
  • Phone: 734-507-1240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801119711
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: