=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477431138
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KITTLESON MSW THERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2025
-----------------------------------------------------
Last Update Date | 08/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1010 S GRINNELL ST
-----------------------------------------------------
City | JACKSON
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49203-2945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-489-9893
-----------------------------------------------------
Fax | 517-523-3311
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1131 N OSSEO RD
-----------------------------------------------------
City | HILLSDALE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 49242-9714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 517-523-3695
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROPRIETOR
-----------------------------------------------------
Name | SHELBY KITTLESON
-----------------------------------------------------
Credential | MSW
-----------------------------------------------------
Telephone | 734-489-9893
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------