MEDICARE: KANDACE GREGORY

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	1041S0200X	School Social Worker

General Provider Information

NPI Number	:	1851229306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANDACE GREGORY

Provider Business Mailing Address
First Line	:	15460 MAPLERIDGE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48205-3029
Country	:	US
Telephone Number	:	313-418-7126
Fax Number	:	313-418-7126

Provider Business Practice Location Address
First Line	:	13000 W 7 MILE RD
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48235-1335
Country	:	US
Telephone Number	:	313-418-7126
Fax Number	:

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

Provider Enumeration Date	:	05/13/2026
Last Update Date	:	05/13/2026

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Directions to “ KANDACE GREGORY ” Practice Location

Language	Start Address	Practice Location

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