MEDICARE: KAYLA MARIE GADDIS LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801109807	MI

General Provider Information

NPI Number	:	1346172376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA MARIE GADDIS LMSW

Provider Business Mailing Address
First Line	:	4515 S SHORE ST
Second Line	:
City	:	WATERFORD
State	:	MI
Zip	:	48328-1163
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1149 HILTON RD STE 200
Second Line	:
City	:	FERNDALE
State	:	MI
Zip	:	48220-2986
Country	:	US
Telephone Number	:	313-228-6404
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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