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General NPI Number Information
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NPI Number | 1831978923
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Entity Type | Individual
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Provider Name | KAELYN WEISBROD
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Gender | Female
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Dates
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Enumeration Date | 09/27/2023
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Last Update Date | 10/27/2023
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Provider Practice Location Address
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Address Line | 39000 7 MILE RD STE 2300
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City | LIVONIA
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State | MI
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Zip | 48152-1006
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Country | US
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Telephone | 734-292-8589
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Fax |
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Provider Business Mailing Address
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Address Line | 1814 15TH ST
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City | WYANDOTTE
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State | MI
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Zip | 48192-3616
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Country | US
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Telephone | 517-581-0998
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6851116910
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License Number State | MI
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