Healthcare Provider Details

I. General information

NPI: 1023543402
Provider Name (Legal Business Name): KAYLA RAE WOJDA PYSD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2017
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 MUNSON AVE STE E
TRAVERSE CITY MI
49686-3661
US

IV. Provider business mailing address

880 MUNSON AVE STE E
TRAVERSE CITY MI
49686-3661
US

V. Phone/Fax

Practice location:
  • Phone: 989-657-5779
  • Fax:
Mailing address:
  • Phone: 989-657-5779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301019174
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: