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General NPI Number Information
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NPI Number | 1730092719
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Entity Type | Individual
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Provider Name | MIKENNA BAYLESS LLMSW
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Gender | Female
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Dates
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Enumeration Date | 09/23/2026
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Last Update Date | 09/23/2026
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Provider Practice Location Address
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Address Line | 321 E OHIO ST
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City | MARQUETTE
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State | MI
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Zip | 49855-3847
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Country | US
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Telephone | 906-226-5161
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Fax | 906-226-5134
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Provider Business Mailing Address
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Address Line | 2942 CEDARVILLE DR APT 2
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City | MARQUETTE
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State | MI
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Zip | 49855-8661
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Country | US
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Telephone | 906-226-5100
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Fax | 906-226-5134
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 6851120263
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License Number State | MI
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