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NPI Code Detail

MEDICARE: KAITLYN MCDONALD LLMSW

MEDICARE: KAITLYN MCDONALD LLMSW
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1417790031
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITLYN MCDONALD LLMSW
Provider Business Mailing Address
First Line : 3210 STONE ST
Second Line :
City : PORT HURON
State : MI
Zip : 48060-2155
Country : US
Telephone Number : 810-984-4202
Fax Number :
Provider Business Practice Location Address
First Line : 520 SUPERIOR ST
Second Line :
City : PORT HURON
State : MI
Zip : 48060-3838
Country : US
Telephone Number : 810-984-4202
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2024
Last Update Date : 03/31/2026

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