Healthcare Provider Details

I. General information

NPI: 1922932755
Provider Name (Legal Business Name): JILLIAN KWAPIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48673 HAYES RD
SHELBY TOWNSHIP MI
48315-4403
US

IV. Provider business mailing address

25797 MARITIME CIR S
HARRISON TOWNSHIP MI
48045-3074
US

V. Phone/Fax

Practice location:
  • Phone: 586-745-9020
  • Fax: 586-777-7855
Mailing address:
  • Phone: 586-777-3200
  • Fax: 586-777-7855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6451024939
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: