Healthcare Provider Details

I. General information

NPI: 1558053983
Provider Name (Legal Business Name): KAITLYN HOPE MALO LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24445 NORTHWESTERN HWY STE 100
SOUTHFIELD MI
48075-2436
US

IV. Provider business mailing address

1978 WHITE OAK LN
YPSILANTI MI
48198-9548
US

V. Phone/Fax

Practice location:
  • Phone: 248-483-7804
  • Fax:
Mailing address:
  • Phone: 989-522-0956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801121152
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: