Healthcare Provider Details

I. General information

NPI: 1962003780
Provider Name (Legal Business Name): KAITLYN MARIE HEUER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLYN MARIE KINSEY

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51539 VAN DYKE AVE
SHELBY TWP MI
48316-4447
US

IV. Provider business mailing address

23614 MARLBOROUGH DR
CLINTON TWP MI
48036-1221
US

V. Phone/Fax

Practice location:
  • Phone: 586-461-2111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801104769
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: